An Autopsy Report of Fulminant Type 1 Diabetes Mellitus that Developed During Anti-programmed Cell Death-1 Treatment

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  • Mukaida Sachiyo
    Department of Endocrinology and Diabetes, Ome Municipal General Hospital
  • Adachi Junichiro
    Department of Endocrinology and Diabetes, Ome Municipal General Hospital
  • Otsubo Naoya
    Department of Endocrinology and Diabetes, Ome Municipal General Hospital
  • Matsuda Yusuke
    Department of Endocrinology and Diabetes, Ome Municipal General Hospital
  • Tomii Shohei
    Department of Pathology, Tokyo Medical and Dental University
  • Kasahara Ichiro
    Department of Pathology, Ome Municipal General Hospital
  • Jinbo Erika
    Okinaka Memorial Institute for Medical Research
  • Fukui Tomoyasu
    Okinaka Memorial Institute for Medical Research Department of Diabetes, Metabolism and Endocrinology, Showa University
  • Kobayashi Tetsuro
    Okinaka Memorial Institute for Medical Research
  • Yamada Tetsuya
    Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical and Dental University

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Other Title
  • 抗PD-1抗体投与中に劇症1型糖尿病を発症した1剖検例

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<p>Our patient is a 77-year-old man with a history of type 2 diabetes and squamous cell carcinoma of the lung. Five months after initiating treatment with pembrolizumab, he was admitted to our hospital due to conscious disturbance. His HbA1c levels were maintained at 6.0 % to 6.5 % while taking an oral antidiabetic drug. Five days before admission, his blood glucose levels were 249 mg/dL with ketonuria at a regular outpatient visit. He developed malaise three days later. On the day of admission, he visited our emergency room due to impaired consciousness and was diagnosed with diabetic ketoacidosis due to fulminant type 1 diabetes. We administered large amounts of fluid and continuous insulin infusion. However, he succumbed 17 h after the admission. A histopathological analysis revealed pathological changes characteristic of fulminant type 1 diabetes, such as decreased pancreatic β and α cells and CD3-positive T cell infiltration. Additionally, we noted a decreased expression of programmed cell death ligand 1 in the pancreatic islets. When immune checkpoint inhibitors are administered to diabetic patients, it is crucial to notify professional healthcare providers and patients of the risk of immune-related type 1 diabetes development.</p>

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