Guimarães Francisco, Polishchuk Nataliya, Almeida Martins Cláudia
Internal Medicine, Hospital CUF Descobertas, Lisbon, PRT.
Family and Community Medicine, USF AlbaSaúde, Sintra, PRT.
Cureus. 2024 Jul 31;16(7):e65906. doi: 10.7759/cureus.65906. eCollection 2024 Jul.
Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have transformed immuno-oncology by demonstrating efficacy against various cancers, including small-cell lung carcinoma and HER2-positive gastric cancer. Despite their benefits, ICIs can provoke immune-related adverse events, with endocrinopathies being rare but carrying significant complications. We report a case of pembrolizumab-induced diabetic ketoacidosis (DKA) in an 87-year-old woman with advanced gastric carcinoma and no prior diabetes history. The patient presented with acute hyperglycemia and metabolic acidosis and was found to have low C-peptide levels without other autoimmune markers typically associated with type 1 diabetes. This case highlights the need for awareness of pembrolizumab as a potential trigger for DKA, especially in patients without a prior diabetes diagnosis. While the management of DKA remains the same, identifying the precipitating factor allows for a comprehensive diagnostic workup and effective long-term management, maintaining the patient's quality of life. This case highlights the complexities of managing DKA in ICI therapy and illustrates the importance of distinguishing between classical DKA presentations and those related to ICIs.
免疫检查点抑制剂（ICIs），如派姆单抗，已通过证明对包括小细胞肺癌和HER2阳性胃癌在内的各种癌症有效，从而改变了免疫肿瘤学。尽管它们有诸多益处，但ICIs可引发免疫相关不良事件，内分泌病虽罕见但会带来严重并发症。我们报告一例87岁晚期胃癌且无糖尿病病史的女性患者，因使用派姆单抗诱发糖尿病酮症酸中毒（DKA）。该患者出现急性高血糖和代谢性酸中毒，且发现C肽水平低，无其他通常与1型糖尿病相关的自身免疫标志物。此病例凸显了需意识到派姆单抗可能是DKA的触发因素，尤其是在既往未诊断糖尿病的患者中。虽然DKA的管理方式不变，但识别诱发因素有助于进行全面的诊断检查和有效的长期管理，维持患者的生活质量。该病例凸显了在ICI治疗中管理DKA的复杂性，并说明了区分经典DKA表现与ICI相关表现的重要性。
