Case report: Immune checkpoint inhibitor-induced fulminant diabetic ketoacidosis: a case-based review and considerations for immunotherapy discontinuation.
To report a case of advanced lung adenocarcinoma (LUAD) harboring KRAS p.G12C and TP53 p.R273C mutations. While immune checkpoint inhibitor (ICI) therapy offered remarkable clinical benefits, it concurrently induced a fatal endocrine complication, highlighting the dual-natured impact of immunotherapy.
An elderly male diagnosed with Stage IV LUAD achieved sustained stable disease (SD) and symptomatic improvement through a sequential therapeutic strategy, including platinum-based chemotherapy followed by the PD-1 inhibitor sintilimab combined with anti-angiogenic agents (apatinib or anlotinib). However, the patient developed severe coma, hyperglycemia and metabolic disorder. Laboratory investigations confirmed fulminant ICI-related diabetic ketoacidosis (DKA). Despite intensive resuscitative efforts, the patient succumbed to multi-organ failure.
This case demonstrates that while ICIs can provide exceptional long-term benefits in advanced NSCLC, particularly in patients with highly immunogenic mutation profiles, they may also trigger late-onset fatal irAEs. Our findings underscore the imperative for close, long-term metabolic surveillance throughout the course of immunotherapy, regardless of treatment duration or radiological stability.
An elderly male diagnosed with Stage IV LUAD achieved sustained stable disease (SD) and symptomatic improvement through a sequential therapeutic strategy, including platinum-based chemotherapy followed by the PD-1 inhibitor sintilimab combined with anti-angiogenic agents (apatinib or anlotinib). However, the patient developed severe coma, hyperglycemia and metabolic disorder. Laboratory investigations confirmed fulminant ICI-related diabetic ketoacidosis (DKA). Despite intensive resuscitative efforts, the patient succumbed to multi-organ failure.
This case demonstrates that while ICIs can provide exceptional long-term benefits in advanced NSCLC, particularly in patients with highly immunogenic mutation profiles, they may also trigger late-onset fatal irAEs. Our findings underscore the imperative for close, long-term metabolic surveillance throughout the course of immunotherapy, regardless of treatment duration or radiological stability.