Acute Exacerbation of Type 1 Diabetes and Transient Thyrotoxicosis Around the Same Time After Anti-PD-1 Antibody Administration in a Lung Cancer Patient

• Published in: Journal of the Japan Diabetes Society Vol. 63; no. 11; pp. 746 - 753
• Main Authors: Ishino, Akiko, Yoneda, Chihiro, Yoshimoto, Mei, Suda, Hiroyuki, Hirano, Sachiko, Katamine, Aki, Ogino, Jun, Onuma, Hiroshi, Koh, Eitetsu, Sekine, Yasuo, Hashimoto, Naotake
• Format: Journal Article
• Language: Japanese
• Published: THE JAPAN DIABETES SOCIETY 30.11.2020
• ISSN: 0021-437X; 1881-588X
• DOI: 10.11213/tonyobyo.63.746

The patient was a 65-year-old man who had been diagnosed with diabetes 3 years previously. An examination revealed an HbA1c level of 10.6 %, which improved to approximately 6 % with diet and exercise therapy. The patient underwent surgery and received chemotherapy for his lung cancer, but mediastinal lymphadenopathy remained. Thus, pembrolizumab, an anti-programmed cell death-1 (PD-1) antibody, was administered. Two months later, steroids were administered for suspected bronchial asthma. The following day, he was admitted due to diabetic ketoacidosis. His anti-glutamic acid decarboxylase (GAD) antibody level was 9.7 U/mL. One month previously, his HbA1c, casual blood glucose, and blood C-peptide immunoreactivity were 6.7 %, 121 mg/dL, and 1.9 ng/mL, respectively. Serum collected prior to anti-PD-1 antibody administration was positive for anti-GAD, anti-thyroglobulin, and anti-thyroid peroxidase antibodies. In this patient with slowly progressive type 1 diabetes accompanied by Hashimoto's disease, the patient's diabetes was acutely exacerbated and thyrotoxicosis occurred around the same time after the administration of anti-PD-1 antibody. This case brings attention to the importance of the early diagnosis and treatment of diabetic ketoacidosis.