title: Fulminant type 1 diabetes mellitus with anti-programmed cell death-1 therapy.
abstract: Anti-programmed cell death-1 (PD-1) antibodies are regarded as a risk factor for insulin-dependent diabetes mellitus as a side-effect. While a small number of cases have been reported, evidence remains limited. This is the first report of an Asian patient developing insulin-dependent diabetes during anti-PD-1 therapy. A 55-year-old euglycemic woman receiving nivolumab for malignant melanoma showed abrupt onset of ketonuria, and elevated levels of plasma glucose (580 mg/dL) and hemoglobin A1c (7.0%). Over the next 2 weeks, serum C-peptide levels fell below the limit of detection. Islet autoantibodies were negative, and the patient showed a human leukocyte antigen haplotype associated with type 1 diabetes. Anti-PD-1 therapy can cause rapid onset of insulin-dependent diabetes, possibly because of inappropriate activation of T cells. Human leukocyte antigen haplotypes might be related to the onset of this disease. Physicians should be aware of this serious adverse event and carry out routine blood glucose testing during anti-PD-1 therapy.
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Koro
authors.initials: K
authors.lastname: Gotoh
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Masaki
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ozeki
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Hisae
authors.initials: H
authors.lastname: Ando
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Anai
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kakuma
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan. hiro-405@cb3.so-net.ne.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Shibata
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000139:chemically induced* / Q000276:immunology; D005260:Female; D006801:Humans; D008545:Melanoma / Q000188:drug therapy; D008875:Middle Aged; D000077594:Nivolumab; D061026:Programmed Cell Death 1 Receptor / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D000077594:Nivolumab
keywords: Anti-programmed cell death-1 antibodies; Fulminant type 1 diabetes; Nivolumab