Tohoku J. Exp. Med., 2016 June, 239(2)

Nivolumab, an Anti-Programmed Cell Death-1 Antibody, Induces Fulminant Type 1 Diabetes

YUKA MIYOSHI,¹ OSAMU OGAWA¹ and YU OYAMA²

¹Department of Diabetes and Endocrinology, Kameda Medical Center, Kamogawa, Chiba, Japan
²Department of Oncology, Kameda Medical Center, Kamogawa, Chiba, Japan

Programmed cell death-1 (PD-1), an immunoreceptor, is located on T cells and pro-B cells and interacts with its ligands to inhibit T cell activation and proliferation, thereby promoting immunological self-tolerance. Nivolumab, an anti-PD1 antibody, blocks PD-1 and can restore anticancer immune responses by abrogating PD-1 pathway-mediated T-cell inhibition. Autoimmune adverse events are expected with PD-1 therapy. Fulminant type 1 diabetes is the subtype of type 1 diabetes. The clinical feature is the extremely rapid progression of hyperglycemia and ketoacidosis. Here we describe a 66-year-old woman with advanced melanoma who was treated with nivolumab. After 4 months and six doses of the medicine, the patient was admitted to the hospital with complaints of nausea and vomiting. The laboratory data showed ketonuria, hyperglycemia (531 mg/dl), high anion gap metabolic acidosis, HbA1c (7.3%), and absence of insulin-secreting capacity. These data are compatible with the criteria of fulminant type 1 diabetes. The patient was diagnosed with diabetic ketoacidosis because of fulminant type 1 diabetes. The findings of this case indicated that nivolumab can cause fulminant type 1 diabetes. Diabetic ketoacidosis due to fulminant type 1 diabetes is potentially fatal condition. Thus, diabetic ketoacidosis due to fulminant type 1 diabetes should be considered in the differential diagnosis when patients treated with nivolumab complain of gastrointestinal symptoms.

keywords —— © 1 Tohoku University Medical Press

© 2016 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2016, 239, 155-158

Correspondence: Yuka Miyoshi, Department of Diabetes and Endocrinology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.

e-mail: miyoshi.yuka@kameda.jp