{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:17:59Z","timestamp":1790983079855,"version":"4.1.0"},"reference-count":6,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["IJU Case Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cytokine release syndrome (CRS) is a systemic inflammatory response triggered by various factors, including infection and immunotherapy. Due to its nonspecific presentation, distinguishing CRS from other life\u2010threatening conditions remains challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 79\u2010year\u2010old male receiving lenvatinib plus pembrolizumab for metastatic renal cell carcinoma presented with high\u2010grade fever, altered mental status, and respiratory failure on day 4 of treatment. After excluding infectious etiologies and endocrine dysfunction, CRS was suspected and confirmed by elevated interleukin\u20106 levels. Lenvatinib and pembrolizumab were discontinued, and the patient was treated with tocilizumab and dexamethasone. Clinical improvement was achieved by day 7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CRS should be considered a potential cause of unexplained shock in patients receiving immune checkpoint inhibitors. Early diagnostic consideration is vital for timely intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/iju5.70228","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T02:34:21Z","timestamp":1786156461000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Case of Cytokine Release Syndrome (CRS) Related to Treatment With Lenvatinib Plus Pembrolizumab for Metastatic Clear Cell Renal Cell Carcinoma"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3103-2043","authenticated-orcid":false,"given":"Kei","family":"Nagase","sequence":"first","affiliation":[{"name":"Department of Urology Imari\u2010Arita Kyoritsu Hospital  Saga Japan"},{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"},{"name":"Department of Urology Youmeikai Obase Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9460-8759","authenticated-orcid":false,"given":"Hiroaki","family":"Kakinoki","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1618-1646","authenticated-orcid":false,"given":"Shuhei","family":"Kusano","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5052-0063","authenticated-orcid":false,"given":"Yuka","family":"Kakinoki","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5411-1377","authenticated-orcid":false,"given":"Maki","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Udo","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"},{"name":"Department of Urology Kumamoto Kenhoku Hospital  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8266-6652","authenticated-orcid":false,"given":"Shohei","family":"Tobu","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine Saga University  Saga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000525173"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/20565623.2024.2422786"},{"issue":"3","key":"e_1_2_10_4_1","first-page":"511","article-title":"In Vivo Administration of Anti\u2010CD3 Monoclonal Antibody in Kidney Allograft Recipients. A First Report of the Immunologic, Pharmacologic, and Clinical Results","volume":"47","author":"Chatenoud L.","year":"1989","journal-title":"Transplantation"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01387-6"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3892\/mmr.2025.13578"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"}],"container-title":["IJU Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/iju5.70228","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/iju5.70228","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/iju5.70228","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:42:24Z","timestamp":1790322144000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/iju5.70228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":6,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/iju5.70228"],"URL":"https:\/\/doi.org\/10.1002\/iju5.70228","archive":["Portico"],"relation":{},"ISSN":["2577-171X","2577-171X"],"issn-type":[{"value":"2577-171X","type":"print"},{"value":"2577-171X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"2026-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70228"}}