Diabetisk ketoacidose etter immunterapi mot lungekreft

We report on the first published case of diabetic ketoacidosis related to cancer immunotherapy in Norway. Immune checkpoint inhibitors are used to treat several types of cancer. These drugs can cause unique immune-related adverse events. A man in his sixties with PD-L1-positive metastatic adenocarcinoma of the lung was treated with two doses of pembrolizumab. Approximately two months later he was admitted to a district hospital with severe diabetic ketoacidosis, with pH of 7.18 and blood glucose level of 69.7 mmol/l. Anti-GAD and anti-IA2 antibodies were negative. C-peptide level was <7 pmol/l after treatment. He recovered and is now being treated with standard insulin therapy. Clinicians should be aware of this rare complication of cancer immunotherapy.