Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

• Published in: European journal of case reports in internal medicine Vol. 8; no. 8; p. 002756
• Main Authors: Saleh, Ahmed Osman, Taha, Ruba, Mohamed, Shehab Fareed A, Bashir, Mohammed
• Format: Journal Article
• Language: English
• Published: Italy SMC Media Srl 13.08.2021; SMC MEDIA SRL
• Subjects: checkpoint inhibitors; diabetes mellitus; dka; hhs; nivolumab; HHS; diabetes mellitus; DKA; nivolumab; checkpoint inhibitors
• ISSN: 2284-2594; 2284-2594
• DOI: 10.12890/2021_002756

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic. Checkpoint inhibitor-associated diabetes can present abruptly with life-threatening complications.Most patients require multiple daily injections of insulin upon discharge.Cessation of checkpoint inhibitor therapy does not revert diabetes.