Anti-PD1 Pembrolizumab Can Induce Exceptional Fulminant Type 1 Diabetes

A 44-year-old Caucasian woman with no history of diabetes was admitted to the emergency department in 2014 for vomiting and confusion, with polyuria, polydipsia, and a very recent weight loss (15 days). Biological tests revealed severe hyperglycemia and diabetic ketoacidosis (glycemia 50.45 mmol/L, ketones 3+, pH 7.25, HCO3− 3 mEq/L), with acute renal failure (39 mL/min/1.73 m2) and elevated serum lipase. Pancreatitis was ruled out by an abdominal computed tomography scan. Intravenous insulin resulted in rapid glycemic control. Surprisingly, HbA1c was subnormal (6.85%). Furthermore, anti-GAD and anti-IA2 antibodies were negative and serum C-peptide was undetectable. All these parameters led to the unusual diagnosis of fulminant type 1 diabetes (FD). FD is a rare subtype of type 1 diabetes …