What does this research mean for the field?

Severe inflammatory cystitis and ureteritis is a rare but clinically significant adverse effect of TCHP chemotherapy that can present with haematuria and acute kidney injury, and is responsive to corticosteroid therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 10, 2026Cureus0 citationsOpen Access

Severe Inflammatory Cystitis and Ureteritis Following Neoadjuvant TCHP (Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab) Therapy in HER2-Positive Breast Cancer: A Case Report and Literature Review

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: HER2-positive breast cancer (n=1). Intervention: Neoadjuvant TCHP (Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab). Primary outcome: Development of severe inflammatory cystitis and ureteritis.

NMNavin MathiyalaganNottingham University Hospitals NHS Trust EREric RahulMMA Design (United States)MSMuhammad Adeel SarwarNottingham University Hospitals NHS Trust

Key Result

Neoadjuvant TCHP therapy induced severe inflammatory cystitis, bilateral ureteritis, and acute kidney injury in a 65-year-old woman, which resolved rapidly following corticosteroid administration.

Key Points

This case report aims to highlight the rare occurrence of severe inflammatory cystitis and ureteritis following TCHP therapy in a HER2-positive breast cancer patient.
A 65-year-old woman with HER2-positive T2N1 breast cancer presented with haematuria and acute kidney injury after neoadjuvant TCHP therapy.
Imaging studies (ultrasound and CT) were performed to assess kidney complications, and management included bladder irrigation, IV fluids, antibiotics, and corticosteroids.
The patient's progress was monitored following the initiation of oral prednisolone.
The patient exhibited a marked clinical response within 72 hours of corticosteroid treatment with resolution of haematuria.
Renal function recovered to baseline levels after corticosteroid initiation.
Surgery was ultimately chosen over continued chemotherapy due to the patient’s poor tolerance and anxiety surrounding systemic therapy.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 65-year-old woman with HER2-positive breast cancer who developed severe urothelial toxicity after her first cycle of neoadjuvant TCHP chemotherapy.

Intervention

Neoadjuvant TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) therapy, followed by oral prednisolone 60 mg once daily for urothelial toxicity

Outcome

Resolution of haematuria and recovery of renal functionsafety

Highlights chemotherapy-associated urothelial toxicity as a rare but clinically significant adverse effect of TCHP therapy that responds to corticosteroids.

Limitations

No histopathological confirmation (renal or bladder biopsy was not performed).
Single case report limits definitive mechanistic interpretation.
Definitive causality of a specific agent remains difficult to establish in a multi-drug setting.

Abstract

Haematuria is a rare complication in patients receiving docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) chemotherapy for breast cancer, with only a few cases reported. Here, we describe a 65-year-old woman with HER2-positive T2N1 breast cancer who developed visible haematuria and acute kidney injury (AKI) after her first cycle of neoadjuvant TCHP therapy. Ultrasound and computed tomography (CT) imaging of the renal tract demonstrated mild bilateral hydronephrosis and moderate bilateral hydroureter associated with inflammatory fat stranding, with findings most consistent with chemotherapy-associated inflammatory ureteritis and cystitis. Initial management included continuous bladder irrigation, intravenous fluids, and empirical antibiotic therapy. However, persistent haematuria and worsening renal function despite supportive treatment prompted initiation of oral prednisolone 60 mg once daily for presumed inflammatory urothelial toxicity. The patient showed a marked clinical response within 72 hours of corticosteroid initiation, with resolution of haematuria and recovery of renal function to baseline. Following multidisciplinary team (MDT) discussion, and given poor tolerance of systemic therapy alongside significant treatment-related anxiety, a decision was made to proceed directly to surgery rather than continue neoadjuvant chemotherapy. This case highlights chemotherapy-associated urothelial toxicity as a rare but clinically significant adverse effect of TCHP therapy and the need for early recognition and multidisciplinary management. A focused review of previously reported cases is also presented.

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