Nishihama Kota, Okano Yuko, Inoue Chisa, Maki Kanako, Eguchi Kazuhito, Tanaka Soichiro, Takeshita Atsuro, Uemura Mei, Yasuma Taro, Suzuki Toshinari, Gabazza Esteban C, Yano Yutaka
Department of Diabetes, Metabolism, and Endocrinology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507 Japan.
Department of Immunology, Mie University Graduate School of Medicine, Tsu, Japan.
Diabetol Int. 2024 Mar 11;15(3):583-588. doi: 10.1007/s13340-024-00703-y. eCollection 2024 Jul.
The case was an 80-year-old Japanese man. He was diagnosed with right renal cell carcinoma when he was 74. After laparoscopic radical nephrectomy, the patient received interferon, sorafenib, axitinib, and nivolumab therapy. The patient developed rapid progressive insulin-dependent diabetes mellitus (DM) after 46 courses of nivolumab monotherapy (772 days from the first nivolumab treatment). Glutamic acid decarboxylase antibody, islet cell cytoplasmic antibody, islet cell antigen-2 antibody, insulin antibody, and zinc transporter 8 antibody were all negative. Human leukocyte antigen (HLA) typing showed DRB1*09:01, DRB1 13:02, DQB103:03, and DQB1 *06:04. Multiple daily insulin injections were started. However, controlling his blood glucose by standard multiple daily insulin injection treatments was difficult. The patient survived more than two years after the onset of immune checkpoint inhibitor-associated DM (ICI-DM). This is a valuable report of late-onset ICI-DM with a detailed patient background and clinical course over two years after the first dose of nivolumab.
该病例为一名80岁的日本男性。他在74岁时被诊断为右肾细胞癌。在接受腹腔镜根治性肾切除术后，患者接受了干扰素、索拉非尼、阿昔替尼和纳武单抗治疗。在接受46个疗程的纳武单抗单药治疗后（自首次使用纳武单抗治疗起772天），患者出现了快速进展的胰岛素依赖型糖尿病（DM）。谷氨酸脱羧酶抗体、胰岛细胞胞浆抗体、胰岛细胞抗原2抗体、胰岛素抗体和锌转运体8抗体均为阴性。人类白细胞抗原（HLA）分型显示为DRB1*09:01、DRB1 13:02、DQB103:03和DQB1 *06:04。开始每日多次注射胰岛素。然而，通过标准的每日多次胰岛素注射治疗来控制他的血糖很困难。该患者在免疫检查点抑制剂相关糖尿病（ICI-DM）发病后存活了两年多。这是一份关于迟发性ICI-DM的有价值报告，详细介绍了患者背景和自首次使用纳武单抗起两年多的临床病程。
