Systemic Toxicity With Hyperglycemia or Diabetic Ketoacidosis After Enfortumab Vedotin: Single-Center Case Series

Systemic Toxicity With Hyperglycemia or Diabetic Ketoacidosis After Enfortumab Vedotin: Single-Center Case Series

Enfortumab vedotin (EV) revolutionized management of metastatic urothelial carcinoma. Multiple-organ dysfunction is a rare adverse event associated with EV with unknown mechanisms. We report three cases of unusual EV systemic toxicity with hyperglycemia and/or diabetic ketoacidosis (DKA) shortly aft...

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Main Authors: Mohammad Jad Moussa, Nathaniel R. Wilson, Anindita Ghosh, Meenakshi B. Bhattacharjee, Jonathan L. Curry, Woo Cheal Cho, Anisha B. Patel, Mouhammed Amir Habra, Sonali N. Thosani, Matthew T. Campbell, Arlene O. Siefker-Radtke, Omar Alhalabi, Nupur J. Kikani
Format: Article
Language:English
Published: American College of Physicians 2025-05-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2024.0465
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Summary:Enfortumab vedotin (EV) revolutionized management of metastatic urothelial carcinoma. Multiple-organ dysfunction is a rare adverse event associated with EV with unknown mechanisms. We report three cases of unusual EV systemic toxicity with hyperglycemia and/or diabetic ketoacidosis (DKA) shortly after EV administration. The first case demonstrated insulin-resistant DKA requiring large doses of insulin, high C-peptide levels consistent with intact pancreatic β-cell function, cutaneous eruption, and fatal hemodynamic shock. The second case presented with hyperglycemia, symmetrical muscle weakness, and diffuse cutaneous eruption. The third consisted of mild DKA, rash, jaundice, and confusion. We discuss these severe presentations and empirical therapeutic approaches.
ISSN:2767-7664

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