{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:49:53Z","timestamp":1787017793519,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JUSTICE Group 3"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Endocrinology"],"published-print":{"date-parts":[[2024,3,22]]},"abstract":"<jats:p>\n                    Immune checkpoint inhibitors (ICIs) have become a focal point in cancer immunotherapy, though their utilization is also linked to the occurrence of diverse immune-related adverse events (irAEs). Herein, we present details of a 42-year-old woman diagnosed with a malignant vaginal melanoma who underwent ICI therapy with the combination of nivolumab and ipilimumab. Approximately two months after initiating therapy, the patient manifested destructive thyroiditis and fulminant type 1 diabetes mellitus, thus necessitating intensive insulin therapy. Following the onset of adrenocorticotropic hormone deficiency, frequent hypoglycemic episodes prompted the initiation of replacement therapy with hydrocortisone. Human leukocyte antigen (HLA)-DNA typing revealed the presence of HLA-DRB1\n                    <jats:inline-formula>\n                      <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:msup>\n                          <a:mrow\/>\n                          <a:mi>\u2217<\/a:mi>\n                        <\/a:msup>\n                      <\/a:math>\n                    <\/jats:inline-formula>\n                    04\u2009:\u200905 and DQB1\n                    <jats:inline-formula>\n                      <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:msup>\n                          <c:mrow\/>\n                          <c:mi>\u2217<\/c:mi>\n                        <\/c:msup>\n                      <\/c:math>\n                    <\/jats:inline-formula>\n                    04\u2009:\u200901. HLA-DR4 has been suggested to be associated with the development of multiple endocrine irAEs. This is the first reported case of three endocrine irAEs occurring within a short period, in which the presence of HLA-DR4 may have contributed to the pathogenesis.\n                  <\/jats:p>","DOI":"10.1155\/2024\/4662803","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T22:50:05Z","timestamp":1711147805000},"page":"1-6","source":"Crossref","is-referenced-by-count":3,"title":["A Case in Which HLA-DR4 is Involved in the Development of Complex Immune-Related Endocrinological Adverse Events following Combination Therapy with Nivolumab and Ipilimumab"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7091-5639","authenticated-orcid":true,"given":"Yonekazu","family":"Kidawara","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3541-5270","authenticated-orcid":true,"given":"Manabu","family":"Kadoya","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Kakutani-Hatayama","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Koyama","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-021-00514-z"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31105"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1910836"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-020-0897-9"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15245786"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa553"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-016-0196-z"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-019-0713-y"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1210\/js.2018-00366"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.244.33"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0889"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2349"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-016-0872-y"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13212"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1530\/eje-19-0291"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13762"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-018-1234-8"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14082"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1530\/ec-20-0342"}],"container-title":["Case Reports in Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crie\/2024\/4662803.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crie\/2024\/4662803.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crie\/2024\/4662803.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T22:50:11Z","timestamp":1711147811000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/crie\/2024\/4662803\/"}},"subtitle":[],"editor":[{"given":"Toshihiro","family":"Kita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,3,22]]},"references-count":19,"alternative-id":["4662803","4662803"],"URL":"https:\/\/doi.org\/10.1155\/2024\/4662803","relation":{},"ISSN":["2090-651X","2090-6501"],"issn-type":[{"value":"2090-651X","type":"electronic"},{"value":"2090-6501","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3,22]]}}}