Medicine · 2025
Development of type 1 diabetes mellitus after nivolumab dose escalation: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mabuchi Sayaka, Adachi Naoko, Nagasawa Atsushi, Nabika Satoshi
Аннотация
RATIONALE: Immune checkpoint inhibitor-induced type 1 diabetes mellitus (ICI-T1DM) is a rare but serious immune-related adverse event associated with programmed cell death-1 inhibitors such as nivolumab. While previous reports have documented its occurrence, the relationship between nivolumab dosing and the onset of ICI-T1DM remains unclear. This study presents a case of ICI-T1DM following a nivolumab dose and includes a literature review.
PATIENT CONCERNS: A man in his 50s (weight: 49.4 kg, body mass index: 17.65 kg/m2) with advanced esophageal cancer had been receiving nivolumab (240 mg every 14 days) for over 2 years without adverse effects. Because of treatment adjustments, the dose was increased to 480 mg and administered every 28 days. Ninety-six days after the dose increase, he developed acute-onset fatigue, anorexia, and thirst.
DIAGNOSES: Laboratory tests confirmed diabetic ketoacidosis with hyperglycemia (582 mg/dL), low C-peptide levels, and negative islet-associated antibodies, leading to the diagnosis of nivolumab-induced fulminant type 1 diabetes mellitus.
INTERVENTIONS: The patient was treated with insulin and discharged after stabilization.
OUTCOMES: This case suggests that higher dose nivolumab may increase the risk of ICI-T1DM, especially in low body-weight individuals.
LESSONS: Given that nivolumab remains effective at lower doses, dose optimization may help mitigate immune-related adverse events while maintaining therapeutic efficacy.
PATIENT CONCERNS: A man in his 50s (weight: 49.4 kg, body mass index: 17.65 kg/m2) with advanced esophageal cancer had been receiving nivolumab (240 mg every 14 days) for over 2 years without adverse effects. Because of treatment adjustments, the dose was increased to 480 mg and administered every 28 days. Ninety-six days after the dose increase, he developed acute-onset fatigue, anorexia, and thirst.
DIAGNOSES: Laboratory tests confirmed diabetic ketoacidosis with hyperglycemia (582 mg/dL), low C-peptide levels, and negative islet-associated antibodies, leading to the diagnosis of nivolumab-induced fulminant type 1 diabetes mellitus.
INTERVENTIONS: The patient was treated with insulin and discharged after stabilization.
OUTCOMES: This case suggests that higher dose nivolumab may increase the risk of ICI-T1DM, especially in low body-weight individuals.
LESSONS: Given that nivolumab remains effective at lower doses, dose optimization may help mitigate immune-related adverse events while maintaining therapeutic efficacy.