Pembrolizumab-induced Type 1 diabetes mellitus in a patient with MSI-high metastatic rectal cancer

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  • Pembrolizumab投与中に急性発症1型糖尿病を発症したMSI-High直腸癌の1例

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Abstract

<p>Abstract : A 72-year-old man underwent laparoscopic low anterior resection for rectal cancer.　Pathological examination revealed pT3（SS）, pN2b, M0, pStageIIIc, and rectal cancer with microsatellite instability-high （MSI-High）.　After that, pembrolizumab was started due to multiple pulmonary metastases.　On the 4th day after the 11th course of administration, he noticed anorexia, abdominal pain and headache.　Blood tests and computed tomography （CT） showed no intestinal disease.　On the other hand, blood glucose level was as high as 334 mg/dL and HbA1c was 7.1%, indicating impaired glucose tolerance, which had not been noted before.　He was admitted for detailed examination and treat-ment, but hyperglycemia persisted thereafter.　Based on the presence of urinary ketone bodies and a marked decrease in insulin secretion, we diagnosed him with acute-onset type 1 diabetes mellitus as immune-related adverse events （irAE） caused by pembrolizumab.　The patient was discharged on the 16th hospital day after prompt initiation of adequate fluid infusion and insulin therapy without aggravation.　After discharge, he has been treated with pembrolizumab while continuing multiple daily injections insulin therapy.　IrAEs can occur in any organ of the body.　Type 1 diabetes mellitus is known to be one of the rare cases, with an onset frequency of 0.7%, and it may lead to type 1 diabetes mellitus, so prompt diagnosis and treatment are important.　We experienced a case of MSI-High rectal cancer who developed acute-onset type 1 diabetes mellitus while receiving pembrolizumab.　When a sudden rise in blood glucose level and gastrointestinal symptoms are observed during the use of immune checkpoint inhibitors （ICI）, it is important to suspect this disease and to promptly diagnose and start treatment.</p>

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