Immune checkpoint inhibitors-related pancreatitis with fulminant type 1 diabetes mellitus: case report and literature review

Front Immunol. 2023 Sep 28:14:1243773. doi: 10.3389/fimmu.2023.1243773. eCollection 2023.

Abstract

Immune checkpoint inhibitors (ICIs) are increasingly being used in the treatment of advanced human malignancies. ICIs-related adverse events, including pancreatitis and diabetes, have been individually characterized in the literature. The co-occurrence of ICIs-related pancreatitis with diabetes is rare and easily overlooked, but it is often severe or fatal. We present a patient with renal tumor resection who was treated with injection of the PD-L1 inhibitor toripalimab and eventually developed acute pancreatitis and fulminant type 1 diabetes mellitus. In addition, we conducted a literature review of ICIs-related pancreatitis with diabetes. The case in our report presented with paroxysmal abdominal pain and loss of appetite. Intravenous fluids and insulin infusion improved the patient's pancreatitis and explosive hyperglycemia. This article suggests that ICIs can affect endocrine and exocrine functions of the pancreas, while providing information and new perspectives for the diagnosis and treatment of this challenging rare disease, helping inspire clinicians for the early identification and effective management of similar cases.

Keywords: case report; immune checkpoint inhibitors; immune-related adverse events; immunotherapy; literature review.

Publication types

  • Review
  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Diabetes Mellitus, Type 1* / complications
  • Diabetes Mellitus, Type 1* / diagnosis
  • Endocrine System Diseases*
  • Humans
  • Immune Checkpoint Inhibitors / therapeutic use
  • Neoplasms* / drug therapy
  • Pancreatitis* / chemically induced
  • Pancreatitis* / diagnosis

Substances

  • Immune Checkpoint Inhibitors

Grants and funding

This work was funded by the Youth Science and Technology Innovation Project of the Department of Science and Technology of Sichuan Province (grant No.2021049 and No.2022082) and Sichuan Traditional Chinese Medicine Culture Collaborative Development Research Center Project (2022XT101).