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International Journal of Hematology

, Volume 105, Issue 3, pp 383–386 | Cite as

Fulminant type I diabetes mellitus associated with nivolumab in a patient with relapsed classical Hodgkin lymphoma

  • Wataru MunakataEmail author
  • Ken Ohashi
  • Nobuhiko Yamauchi
  • Kensei Tobinai
Case Report

Abstract

We report the case of a patient with relapsed classical Hodgkin lymphoma who developed fulminant type I diabetes mellitus as a severe adverse event of treatment with the anti-programmed cell death-1 (PD-1) antibody, nivolumab. On the first day of the sixth cycle, the blood glucose level was markedly elevated (375 mg/dL). Although neither ketoacidosis nor ketonuria was detected, the markedly acute onset of the hyperglycemia was consistent with the typical clinical course of fulminant type I diabetes mellitus, and this diagnosis was supported by clinical data. All autoantibodies associated with type I diabetes mellitus were negative. The endogenous insulin secretion ceased completely within 2 weeks. After the blood glucose level was brought under control, nivolumab was resumed and continued without other major adverse events. Human leukocyte antigen (HLA) analysis revealed that the patient carried the HLA-B*4002 haplotype, a susceptibility allele for this type of diabetes mellitus. This case suggests that fulminant type I diabetes mellitus may be triggered by nivolumab in patients with a genetic background associated with the condition, warranting careful future consideration of this particular adverse event.

Keywords

Fulminant type I diabetes mellitus Anti-PD-1 antibody Immune-related adverse events Nivolumab 

Notes

Acknowledgments

ONO-4538-15 study was funded by Ono Pharmaceutical Co., Ltd.

Compliance with ethical standards

Conflict of interest

K. Tobinai: Research funding from Ono Pharmaceutical Co., Ltd.

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Copyright information

© The Japanese Society of Hematology 2016

Authors and Affiliations

  1. 1.Department of HematologyNational Cancer Center HospitalTokyoJapan
  2. 2.Department of General Internal MedicineNational Cancer Center HospitalTokyoJapan

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