PT - JOURNAL ARTICLE AU - Hafez Mohammad Ammar Abdullah AU - Radowan Elnair AU - Uzma Ikhtiar Khan AU - Muhammad Omar AU - Oscar L Morey-Vargas TI - Rapid onset type-1 diabetes and diabetic ketoacidosis secondary to nivolumab immunotherapy: a review of existing literature AID - 10.1136/bcr-2019-229568 DP - 2019 Aug 01 TA - BMJ Case Reports PG - e229568 VI - 12 IP - 8 4099 - http://casereports.bmj.com/content/12/8/e229568.short 4100 - http://casereports.bmj.com/content/12/8/e229568.full SO - BMJ Case Reports2019 Aug 01; 12 AB - 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.