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Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab
Joint Authors
Chokr, Nora
Farooq, Hafsa
Guadalupe, Elizabeth
Source
Case Reports in Oncological Medicine
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-01-28
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
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.
American Psychological Association (APA)
Chokr, Nora& Farooq, Hafsa& Guadalupe, Elizabeth. 2018. Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab. Case Reports in Oncological Medicine،Vol. 2018, no. 2018, pp.1-4.
https://search.emarefa.net/detail/BIM-1146643
Modern Language Association (MLA)
Chokr, Nora…[et al.]. Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab. Case Reports in Oncological Medicine No. 2018 (2018), pp.1-4.
https://search.emarefa.net/detail/BIM-1146643
American Medical Association (AMA)
Chokr, Nora& Farooq, Hafsa& Guadalupe, Elizabeth. Fulminant Diabetes in a Patient with Advanced Melanoma on Nivolumab. Case Reports in Oncological Medicine. 2018. Vol. 2018, no. 2018, pp.1-4.
https://search.emarefa.net/detail/BIM-1146643
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1146643