Sintilimab-induced Diabetes Ketoacidosis with multiple organ immune related adverse reactions:A Clinical Case

Corresponding author: JIA Bei, jam.es2009@163.com

DOI: 10.12201/bmr.202411.00022

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  Abstract: We present a 60-year-old male patient with advanced squamous cell carcinoma of the lower thoracic esophagus, accompanied by multiple metastasis,he denied diabetes and other chronic medical history. The Oncologyl department established an immunotherapy combined with chemotherapy regimen : sindelizumab in combination with paclitaxel and cisplatin. Two days after the 4th cycle of treatment, the patient suddenly went into shock coma at the time of admission, unconscious with cold and wet limbs, undetectable blood pressure and less urine. His rapid blood glucose determination showed >33.3 mol·L-1, arterial blood gas analysis suggested acidosis. The patient was then transferred to ICU and treated with vasoactive drugs, insulin and normal saline for volume expansion. His further blood biochemical test showed GLU 58.63 mmol·L-1, urinalysis GLU was 4 + , and urinalysis KET was 2 + , thus the diagnosis of Diabetic ketoacidosis（DKA） was confirmed. AST 557.4 U·L-1 and ALT 100.7 U·L-1 indicated he had a abnormal liver function. The patient in ICU was treated with liver protection and anti-infection therapy,as well as CVVH to maintain the renal function. On the second day after admission, his blood glucose gradually decreased to the controllable range, and the peak values of myocardial injury, liver injury, kidney injury, muscle injury and electrolyte abnormality were detected. He also had an electrolyte disturbance.Considering he may had an immune-related myocardial injury,?he was treated with methylprednisolone 140 mg·d-1,meanwhile symptomatic and supportive treatment.After 15 days, the patients condition was stable, blood glucose was 11.3 mmol·L-1, transaminase returned to normal, NT-proBNP 683pmol·L-1,hs-cTnT 1.01ng·mL-1,Mb 1014ng·mL-1. 6 months later following up,the patient’s fasting blood glucose and serum creatinine were 11.81 mmol·L-1 and 111.2 μmol·L-1 respectively,the markers of heart failure in MI returned to normal.?He is no longer on immunotherapy

  Key words: PD-1?Inhibitor；Sintilimab；Immune-related adverse reactions；Diabetes ketoacidosis；Liver injury；Myocarditis；Myositis；Acute renal insufficiency

  Submit time: 11 November 2024

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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