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CASE REPORT
Rapid onset type-1 diabetes and diabetic ketoacidosis secondary to nivolumab immunotherapy: a review of existing literature
  1. Hafez Mohammad Ammar Abdullah1,
  2. Radowan Elnair1,
  3. Uzma Ikhtiar Khan2,
  4. Muhammad Omar1 and
  5. Oscar L Morey-Vargas3
  1. 1 Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  2. 2 Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
  3. 3 Endocrinology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  1. Correspondence to Dr Hafez Mohammad Ammar Abdullah, ammar.abdullah{at}usd.edu

Abstract

Nivolumab is a programmed cell death receptor (PD-1) inhibitor that is increasingly used for various malignancies, both as a first line agent and as salvage therapy. Being a PD-1/PD-1 ligand checkpoint inhibitor, it is known to cause autoimmune inflammation of various organs and has been associated with thyroiditis, insulitis, colitis, hepatitis and encephalitis to name a few. There are increasing reports of nivolumab leading to acute onset fulminant type 1 diabetes and diabetic ketoacidosis (DKA). We present a case of a 68-year-old man who developed DKA after 2 doses of nivolumab for metastatic melanoma. He was found to have type 1 diabetes, but no diabetes related antibodies were positive. He recovered from diabetes and continues to use insulin 1 year after his diagnosis. This case and associated review illustrates the importance of educating and monitoring patients who start nivolumab therapy regarding this potentially life threatening complication.

  • diabetes
  • chemotherapy
  • immunological products and vaccines
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Footnotes

  • Contributors HMAA, RE, and UIK were involved in writing the background and discussion part. MO and OMV were involved in writing the case presentation and critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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