We report the case of a patient with relapsed classical
Hodgkin lymphoma who developed fulminant type I
diabetes mellitus as a severe adverse event of treatment with the anti-programmed cell death-1 (PD-1) antibody,
nivolumab. On the first day of the sixth cycle, the
blood glucose level was markedly elevated (375 mg/dL). Although neither
ketoacidosis nor
ketonuria was detected, the markedly acute onset of the
hyperglycemia was consistent with the typical
clinical course of fulminant type I
diabetes mellitus, and this diagnosis was supported by clinical data. All
autoantibodies associated with type I
diabetes mellitus were negative. The endogenous insulin secretion ceased completely within 2 weeks. After the
blood glucose level was brought under control,
nivolumab was resumed and continued without other major adverse events.
Human leukocyte antigen (HLA) analysis revealed that the patient carried the
HLA-B*4002 haplotype, a susceptibility allele for this type of
diabetes mellitus. This case suggests that fulminant type I
diabetes mellitus may be triggered by
nivolumab in patients with a genetic background associated with the condition, warranting careful future consideration of this particular adverse event.