Immune checkpoint inhibitor-induced takotsubo syndrome and diabetic ketoacidosis: rare reactions

BMJ Case Rep. 2021 Feb 1;14(2):e237217. doi: 10.1136/bcr-2020-237217.

Abstract

Immune checkpoint inhibitors (ICIs) are increasingly used to treat certain malignancies due to their higher efficacy compared with conventional chemotherapy. As familiarity with these agents increases, it is becoming apparent that a significant number of patients treated with ICIs experience adverse events. With time, more immune-related adverse events (IRAEs) are being recognised. It is important to be vigilant for IRAEs and recognise that a patient may have multiple IRAEs affecting multiple organ systems. Common cardiovascular adverse events associated with ICIs include myocarditis, arrhythmias and pericarditis. This case report identifies a patient presenting with takotsubo syndrome followed by ketoacidosis (associated with sodium-glucose transport protein 2 (SGLT2) inhibitor) in the setting of combination ipilimumab and nivolumab therapy for metastatic melanoma.

Keywords: cancer - see oncology; cardiovascular medicine; diabetes; drugs and medicines; unwanted effects / adverse reactions.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Aged
  • Benzhydryl Compounds / adverse effects
  • Brain Neoplasms / complications
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / secondary
  • Coronary Angiography
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Ketoacidosis / chemically induced*
  • Diabetic Ketoacidosis / complications
  • Echocardiography
  • Glucosides / adverse effects
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Ipilimumab / adverse effects
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / complications
  • Melanoma / drug therapy*
  • Melanoma / secondary
  • Nivolumab / adverse effects
  • Sodium-Glucose Transporter 2 Inhibitors / adverse effects*
  • Takotsubo Cardiomyopathy / chemically induced*
  • Takotsubo Cardiomyopathy / complications
  • Takotsubo Cardiomyopathy / diagnostic imaging

Substances

  • Benzhydryl Compounds
  • Glucosides
  • Immune Checkpoint Inhibitors
  • Ipilimumab
  • Sodium-Glucose Transporter 2 Inhibitors
  • Nivolumab
  • empagliflozin