2021 Volume 64 Issue 3 Pages 169-177
A 71-year-old man was referred by the Department of Urology to our department due to the development of hyperglycemia approximately 7 months after the initiation of programmed cell death protein-1 (PD-1) inhibitor therapy using nivolumab for the treatment of multiple metastatic lesions after renal cell carcinoma resection. Endogenous insulin secretion was not depleted and was comparatively maintained at the first visit; however, marked hyperglycemia (blood glucose level: 736 mg/dL) and mild ketoacidosis were observed. His HbA1c level was found to be relatively low (7.6 %), and the patient tested negative for all islet-related autoantibodies. Based on these findings, the patient was diagnosed with fulminant type 1 diabetes. The human leukocyte antigen (HLA) gene was homozygous for DRB1*09:01-DQB1 *03:03. After injecting insulin subcutaneously multiple times per day, the control of the glycemic levels improved. Several cases of fulminant type 1 diabetes due to anti-PD1 antibody treatment have been reported globally. Based on a systematic review of the relevant literature, we ascertained a few characteristics that were specific to this type of diabetes by comparing them to those in our previous cases of typical fulminant type 1 diabetes.
