{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:18:47Z","timestamp":1764260327520,"version":"3.41.2"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>The occurrence of fulminant type 1 diabetes mellitus as an adverse event during cancer immunotherapy has been previously reported. However, little is known about the causal relationship between the coronavirus disease 2019 (COVID-19) vaccination and fulminant type 1 diabetes mellitus. A 60-year-old man with advanced gastric cancer, receiving S-1 + oxaliplatin and nivolumab therapy, followed by nab-paclitaxel + ramucirumab as a second-line treatment, with steroid supplementation for complications of hypopituitarism-induced hypoadrenocorticism, was administered a COVID-19 vaccine after three cycles of nab-paclitaxel + ramucirumab. Two days later, he developed severe malaise and anorexia, which required emergency admission to our hospital for suspected adrenal insufficiency. Despite increasing steroids, his general condition changed suddenly after 12 hours leading to his death. Histopathological analysis of autopsy samples revealed loss of the islets of Langerhans, indicating fulminant type 1 diabetes mellitus. We failed to recognize the onset of fulminant type 1 diabetes mellitus because its symptoms were similar to those of adrenal insufficiency. The number of reports on the onset of fulminant type 1 diabetes mellitus after COVID-19 vaccination has been increasing, and in this case, the onset occurred on the second day after COVID-19 vaccination, suggesting an association between vaccination and fulminant type 1 diabetes mellitus. Clinicians should be aware of the risk of fulminant type 1 diabetes mellitus, although rare, after COVID-19 vaccination.<\/jats:p>","DOI":"10.3389\/fonc.2023.1264281","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T10:36:31Z","timestamp":1703068591000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Case report: A case of fulminant type 1 diabetes mellitus after COVID-19 vaccination during treatment of advanced gastric cancer: pitfall in managing immune-related adverse events"],"prefix":"10.3389","volume":"13","author":[{"given":"Toshimitsu","family":"Tanaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Nagasu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Furuta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mizuki","family":"Gobaru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasutaka","family":"Shimotsuura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Akiba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatoshi","family":"Nomura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiko","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takumi","family":"Kawaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Miwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0140-6736(21)00797-2","article-title":"First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (Checkmate 649): A randomised, open-label, phase 3 trial","volume":"398","author":"Janjigian","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00692-6","article-title":"Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with her2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (Attraction-4): A randomised, multicentre, double-blind, placebo-controlled, phase 3 trial","volume":"23","author":"Kang","year":"2022","journal-title":"Lancet Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2017.08.022","article-title":"Early immune-related adverse events and association with outcome in advanced non-small cell lung cancer patients treated with nivolumab: A prospective cohort study","volume":"12","author":"Teraoka","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.1051","article-title":"Treatment of the immune-related adverse effects of immune checkpoint inhibitors: A review","volume":"2","author":"Friedman","year":"2016","journal-title":"JAMA Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.3199","article-title":"Sars-Cov-2 vaccines","volume":"325","author":"Creech","year":"2021","journal-title":"JAMA"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e6473","DOI":"10.1002\/ccr3.6473","article-title":"New-onset atypical fulminant type 1 diabetes after Covid-19 vaccination: A case report","volume":"10","author":"Kobayashi","year":"2022","journal-title":"Clin Case Rep"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.16304","article-title":"Fulminant type 1 diabetes mellitus triggered by coronavirus disease 2019 vaccination in an advanced melanoma patient given adjuvant nivolumab therapy","volume":"49","author":"Ohuchi","year":"2022","journal-title":"J Dermatol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13781","article-title":"Type 1 diabetes mellitus following Covid-19 Rna-based vaccine","volume":"13","author":"Sakurai","year":"2022","journal-title":"J Diabetes Investig"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13771","article-title":"New-onset fulminant type 1 diabetes after severe acute respiratory syndrome Coronavirus 2 vaccination: A case report","volume":"13","author":"Sasaki","year":"2022","journal-title":"J Diabetes Investig"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2022.101324","article-title":"Fulminant type 1 diabetes after Covid-19 vaccination","volume":"48","author":"Tang","year":"2022","journal-title":"Diabetes Metab"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2023.38.e209","article-title":"New-onset fulminant type 1 diabetes following Sars-Cov-2 protein subunit vaccine: A case report and literature review","volume":"38","author":"Huang","year":"2023","journal-title":"J Korean Med Sci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s13340-022-00614-w","article-title":"Diabetic ketoacidosis after the second dose of Sars-Cov-2 Mrna vaccination in a patient with pembrolizumab-induced fulminant type 1 diabetes","volume":"14","author":"Nishino","year":"2023","journal-title":"Diabetol Int"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-017-1768-9","article-title":"A specific antibody to detect transcription factor T-pit: A reliable marker of corticotroph cell differentiation and a tool to improve the classification of pituitary neuroendocrine tumours","volume":"134","author":"Sjostedt","year":"2017","journal-title":"Acta Neuropathol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2177\/jsci.40.90","article-title":"[Clinical practice and mechanism of endocrinological adverse events associated with immune checkpoint inhibitors]","volume":"40","author":"Iwama","year":"2017","journal-title":"Nihon Rinsho Meneki Gakkai Kaishi"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/jitc-2020-000779","article-title":"Pituitary dysfunction induced by immune checkpoint inhibitors is associated with better overall survival in both Malignant melanoma and non-small cell lung carcinoma: A prospective study","volume":"8","author":"Kobayashi","year":"2020","journal-title":"J Immunother Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.12024","article-title":"Report of the committee of the Japan diabetes society on the research of fulminant and acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012)","volume":"3","author":"Imagawa","year":"2012","journal-title":"J Diabetes Investig"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2017.07.021","article-title":"Nivolumab-induced acute diabetes mellitus and hypophysitis in a patient with advanced pulmonary pleomorphic carcinoma with a prolonged tumor response","volume":"12","author":"Marchand","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13604","article-title":"Onset of fulminant type 1 diabetes mellitus following hypophysitis after discontinuation of combined immunotherapy. A case report","volume":"12","author":"Boswell","year":"2021","journal-title":"J Diabetes Investig"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13306","article-title":"Japanese clinical practice guideline for diabetes 2019","volume":"11","author":"Araki","year":"2020","journal-title":"J Diabetes Investig"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1264281\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T10:36:33Z","timestamp":1703068593000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1264281\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,20]]},"references-count":19,"alternative-id":["10.3389\/fonc.2023.1264281"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1264281","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2023,12,20]]},"article-number":"1264281"}}