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Case report
Atezolizumab-induced type 1 diabetes mellitus in a patient with metastatic renal cell carcinoma
  1. Wedad Rahman,
  2. Anna Conley and
  3. Kristi D Silver
  1. Department of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
  1. Correspondence to Dr. Kristi D Silver; ksilver{at}


Checkpoint inhibitor immunotherapy has revolutionised cancer treatment since its inception. During an inflammatory response, activated cytotoxic T cells expressing programmed cell death protein 1 (PD-1) interact with programmed cell death-ligand 1 (PD-L1) on peripheral tissues to thwart an autoimmune reaction. Cancer cells upregulate PD-L1 expression to evade the immune system and are vulnerable to attack in the presence of PD-1 or PD-L1 checkpoint inhibitors. However, blockade of this pathway also contributes to the unintended side effect of autoimmune endocrinopathies. Atezolizumab, a checkpoint inhibitor against PD-L1, is associated with the rare complication of type 1 diabetes. We present a case of glutamic acid decarboxylase antibody-positive type 1 diabetes developing in a patient with a long-standing history of well-controlled type 2 diabetes following treatment with atezolizumab for metastatic renal cell carcinoma.

  • diabetes
  • chemotherapy

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  • Contributors KDS and WR participated in the care of the reported patient. KDS, AC and WR contributed to the development and writing 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.

  • Patient consent for publication Obtained.

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