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Review
. 2019 Aug 26;12(8):e229568.
doi: 10.1136/bcr-2019-229568.

Rapid onset type-1 diabetes and diabetic ketoacidosis secondary to nivolumab immunotherapy: a review of existing literature

Hafez Mohammad Ammar Abdullah  1 , Radowan Elnair  1 , Uzma Ikhtiar Khan  2 , Muhammad Omar  1 , Oscar L Morey-Vargas  3
Affiliations
Review

Rapid onset type-1 diabetes and diabetic ketoacidosis secondary to nivolumab immunotherapy: a review of existing literature

Hafez Mohammad Ammar Abdullah et al. BMJ Case Rep. .

Abstract

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.

Keywords: chemotherapy; diabetes; immunological products and vaccines.

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Conflict of interest statement

Competing interests: None declared.

References

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