{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:10:55Z","timestamp":1792023055481,"version":"4.4.0"},"reference-count":33,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,11,9]]},"abstract":"<jats:p>Immune checkpoint inhibitors offer patients with advanced melanoma substantial improvements in survival. Unlike chemotherapy, immune checkpoint inhibitors such as ipilimumab and pembrolizumab cause unique immune-related adverse events (irAEs), including the development of endocrinopathies. We report a case of a man aged 60\u2005years who developed diabetic ketoacidosis (DKA) following the use of pembrolizumab for the treatment of metastatic melanoma. He received four cycles of ipilimumab, before proceeding to pembrolizumab. Five weeks after initiating pembrolizumab, he presented in DKA with a pH of 7.0, bicarbonate of 7\u2005mmol\/L, blood glucose of 27\u2005mmol\/L and serum ketones of 5.9\u2005mmol\/L. Antibodies to glutamic acid decarboxylase (anti-GAD) and Islet antigen 2 (IA-2) were negative and C-peptide was low at 57\u2005pmol\/L (300\u20132350\u2005pmol\/L). There was no personal or family history of autoimmune conditions. Standard immunosuppression for irAEs was started using prednisolone in an attempt to salvage \u03b2 cell function but was unsuccessful. To the best of our knowledge, this is the first reported attempt at reversing pembrolizumab-induced type 1 diabetes using glucocorticoids.<\/jats:p>","DOI":"10.1136\/bcr-2016-217454","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T07:02:44Z","timestamp":1479884564000},"page":"bcr2016217454","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":65,"title":["Glucocorticoids did not reverse type 1 diabetes mellitus secondary to pembrolizumab in a patient with metastatic melanoma"],"prefix":"10.1136","volume":"2016","author":[{"given":"Jasna","family":"Aleksova","sequence":"first","affiliation":[{"name":"Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter K H","family":"Lau","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Institute, Cancer Medicine, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Soldatos","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Institute, Cancer Medicine, East Melbourne, Victoria, Australia"},{"name":"Monash Centre for Health Research and Implementation, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"McArthur","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia"},{"name":"Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,11,23]]},"reference":[{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00262-015-1689-1"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.2","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2349"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.3","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.suppl_2.S52"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-012-0954-z"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2014.08.015"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.6","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-1870"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.7","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/dmrr.2421","article-title":"Clinical characteristics and insulin independence of Koreans with new-onset type 2 diabetes presenting with diabetic ketoacidosis","volume":"29","author":"Seok","year":"2013","journal-title":"Diabetes Metab Res Rev"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-030180"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503093"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.10","first-page":"9504","article-title":"Pembrolizumab versus ipilimumab for advanced melanoma: final overall survival analysis of KEYNOTE-006","volume":"34","author":"Schachter","year":"2016","journal-title":"ASCO Meeting Abstracts"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504030"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2306"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.13","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1111\/imj.12819","article-title":"Ipilimumab-induced hypophysitis in melanoma patients: an Australian case series","volume":"45","author":"Lam","year":"2015","journal-title":"Intern Med J"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.14","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv383"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1501824"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.16","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s00262-016-1845-2","article-title":"Determining predictive factors for immune checkpoint inhibitor toxicity: response to Letter to the Editors \u2018A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome","volume":"65","author":"Spain","year":"2016","journal-title":"Cancer Immunol Immunother"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.17","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00262-016-1835-4","article-title":"A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome","volume":"65","author":"Hansen","year":"2016","journal-title":"Cancer Immunol Immunother"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.18","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1620\/tjem.239.155","article-title":"Nivolumab, an anti-programmed cell death-1 antibody, induces fulminant type 1 diabetes","volume":"239","author":"Miyoshi","year":"2016","journal-title":"Tohoku J Exp Med"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.19","doi-asserted-by":"crossref","unstructured":"Teramoto Y , Nakamura Y , Asami Y , et al . Case of type 1 diabetes associated with less-dose nivolumab therapy in a melanoma patient. J Dermatol 2016. doi:10.1111\/1346-8138.13486","DOI":"10.1111\/1346-8138.13486"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.20","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1331"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200002033420501"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.22","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.1236"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.41.6750"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.24","first-page":"9518","article-title":"Overall survival in patients with advanced melanoma (MEL) who discontinued treatment with nivolumab (NIVO) plus ipilimumab (IPI) due to toxicity in a phase II trial (CheckMate 069)","volume":"34","author":"Hodi","year":"2016","journal-title":"ASCO Meeting Abstracts"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.60.8448"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.26","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5876-12-116"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.27","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4075"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.28","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27969"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.29","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0374"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.30","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20022125"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0089561"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.32","doi-asserted-by":"publisher","DOI":"10.1084\/jem.187.3.427"},{"key":"2025082801373897000_2016.nov23_1.bcr2016217454.33","doi-asserted-by":"publisher","DOI":"10.1038\/nature14292"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-217454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:37:54Z","timestamp":1756370274000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-217454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,23]]},"references-count":33,"alternative-id":["10.1136\/bcr-2016-217454"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-217454","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,23]]}}}