Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab
Background. Anti-PD-1 agents were approved for advanced melanoma after the landmark trial Checkmate-037. Anti-PD-1 agents can breach immunologic tolerance. Fulminant diabetes is an immune endocrinopathy that results from a violent immune attack leading to complete destruction of pancreatic beta cell...
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| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Oncological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2018/8981375 |
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| author | Nora Chokr Hafsa Farooq Elizabeth Guadalupe |
| author_facet | Nora Chokr Hafsa Farooq Elizabeth Guadalupe |
| author_sort | Nora Chokr |
| collection | DOAJ |
| description | Background. Anti-PD-1 agents were approved for advanced melanoma after the landmark trial Checkmate-037. Anti-PD-1 agents can breach immunologic tolerance. Fulminant diabetes is an immune endocrinopathy that results from a violent immune attack leading to complete destruction of pancreatic beta cells in genetically predisposed people. We present a rare case of fulminant diabetes precipitated by anti-PD-1 immunotherapy. Case. A 61-year-old male with advanced melanoma presented with a three-day history of nausea, vomiting, and malaise. He was started on nivolumab and ipilimumab. After the third dose, he developed a generalized rash and was prescribed high-dose prednisone. Labs revealed potassium 9.5 mmol/L, sodium 127 mmol/L, bicarbonate <10 mmol/L, blood glucose 1211 mg/dL, anion gap >31 mmol, arterial blood pH 7.14, and beta-hydroxybutyrate 13.7 mmol/L. He was diagnosed with diabetic ketoacidosis. Hemoglobin A1C was 6.9%. C-peptide was undetectable (<0.1 ng/ml). Glutamic acid decarboxylase autoantibodies, zinc transporter 8 autoantibodies, insulin autoantibodies, islet antigen 2 autoantibodies, and islet cell antibodies were all negative. Conclusion. Anti-PD-1 immunotherapy is effective in cancers refractory to standard chemotherapy. These agents can precipitate autoimmune disorders. As the use of anti-PD-1 agents is expected to rise, physicians should be educated about the potential side effects. We recommend conducting routine blood glucose checks in patients on these agents. |
| format | Article |
| id | doaj-art-7c0f1f9ca030493693c25a574c99cbf7 |
| institution | Kabale University |
| issn | 2090-6706 2090-6714 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Case Reports in Oncological Medicine |
| spelling | doaj-art-7c0f1f9ca030493693c25a574c99cbf72025-02-03T05:46:16ZengWileyCase Reports in Oncological Medicine2090-67062090-67142018-01-01201810.1155/2018/89813758981375Fulminant Diabetes in a Patient with Advanced Melanoma on NivolumabNora Chokr0Hafsa Farooq1Elizabeth Guadalupe2Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USADepartment of Internal Medicine, Yale School of Medicine, New Haven, CT, USADepartment of Internal Medicine, Yale School of Medicine, New Haven, CT, USABackground. Anti-PD-1 agents were approved for advanced melanoma after the landmark trial Checkmate-037. Anti-PD-1 agents can breach immunologic tolerance. Fulminant diabetes is an immune endocrinopathy that results from a violent immune attack leading to complete destruction of pancreatic beta cells in genetically predisposed people. We present a rare case of fulminant diabetes precipitated by anti-PD-1 immunotherapy. Case. A 61-year-old male with advanced melanoma presented with a three-day history of nausea, vomiting, and malaise. He was started on nivolumab and ipilimumab. After the third dose, he developed a generalized rash and was prescribed high-dose prednisone. Labs revealed potassium 9.5 mmol/L, sodium 127 mmol/L, bicarbonate <10 mmol/L, blood glucose 1211 mg/dL, anion gap >31 mmol, arterial blood pH 7.14, and beta-hydroxybutyrate 13.7 mmol/L. He was diagnosed with diabetic ketoacidosis. Hemoglobin A1C was 6.9%. C-peptide was undetectable (<0.1 ng/ml). Glutamic acid decarboxylase autoantibodies, zinc transporter 8 autoantibodies, insulin autoantibodies, islet antigen 2 autoantibodies, and islet cell antibodies were all negative. Conclusion. Anti-PD-1 immunotherapy is effective in cancers refractory to standard chemotherapy. These agents can precipitate autoimmune disorders. As the use of anti-PD-1 agents is expected to rise, physicians should be educated about the potential side effects. We recommend conducting routine blood glucose checks in patients on these agents.http://dx.doi.org/10.1155/2018/8981375 |
| spellingShingle | Nora Chokr Hafsa Farooq Elizabeth Guadalupe Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab Case Reports in Oncological Medicine |
| title | Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab |
| title_full | Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab |
| title_fullStr | Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab |
| title_full_unstemmed | Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab |
| title_short | Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab |
| title_sort | fulminant diabetes in a patient with advanced melanoma on nivolumab |
| url | http://dx.doi.org/10.1155/2018/8981375 |
| work_keys_str_mv | AT norachokr fulminantdiabetesinapatientwithadvancedmelanomaonnivolumab AT hafsafarooq fulminantdiabetesinapatientwithadvancedmelanomaonnivolumab AT elizabethguadalupe fulminantdiabetesinapatientwithadvancedmelanomaonnivolumab |