Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma
This case report presents a 57-year-old male with hepatocellular carcinoma who developed Type 1 Diabetes Mellitus (T1DM) and diabetic ketoacidosis (DKA) following treatment with Envafolimab, a PD-L1 immune checkpoint inhibitor. The patient experienced a rapid onset of hyperglycemia and DKA after sev...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1505195/full |
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| author | Youjia Li Kai Qu Xiuli Li Xin Yang Kanghuai Zhang Jiao Xie |
| author_facet | Youjia Li Kai Qu Xiuli Li Xin Yang Kanghuai Zhang Jiao Xie |
| author_sort | Youjia Li |
| collection | DOAJ |
| description | This case report presents a 57-year-old male with hepatocellular carcinoma who developed Type 1 Diabetes Mellitus (T1DM) and diabetic ketoacidosis (DKA) following treatment with Envafolimab, a PD-L1 immune checkpoint inhibitor. The patient experienced a rapid onset of hyperglycemia and DKA after several cycles of Envafolimab, consistent with the pattern of diabetes induced by immune checkpoint inhibitors (ICIs). Notably, the absence of diabetes-related autoantibodies suggests that the diabetes was induced by the immune-modulating effects of Envafolimab rather than a pre-existing autoimmune condition. Management required intensive insulin therapy and a multidisciplinary approach to stabilize the patient’s health. This case underscores the critical need for heightened clinical awareness and early intervention in managing severe immune-related adverse events (irAEs) associated with novel ICIs like Envafolimab. The complexity of autoimmune-related adverse events, such as the negative autoimmune profiles observed in our patient, emphasizes the importance of multidisciplinary collaboration to optimize patient outcomes. We advocate for the establishment of long-term follow-up plans, including regular monitoring for potential irAEs and endocrine function assessments, to address the chronicity of conditions post-ICI treatment. Recognizing the limitations of current understanding, there is a clear call for further research, particularly on identifying biomarkers that may predict adverse reactions to immunotherapy, to guide precision medicine and improve patient safety. |
| format | Article |
| id | doaj-art-7f3458b85d024935b0a8cc2ec4420b14 |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-7f3458b85d024935b0a8cc2ec4420b142025-01-28T06:41:17ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-01-011610.3389/fimmu.2025.15051951505195Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinomaYoujia Li0Kai Qu1Xiuli Li2Xin Yang3Kanghuai Zhang4Jiao Xie5Department of Pharmacy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, ChinaDepartment of Hepatobiliary-Pancreatic and Liver Transplantation, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, ChinaDepartment of Geriatric Endocrinology, the Second Affiliated Hospital of Xi′an Jiaotong University, Xi’an, ChinaDepartment of Pharmacy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, ChinaDepartment of Pharmacy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, ChinaDepartment of Pharmacy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, ChinaThis case report presents a 57-year-old male with hepatocellular carcinoma who developed Type 1 Diabetes Mellitus (T1DM) and diabetic ketoacidosis (DKA) following treatment with Envafolimab, a PD-L1 immune checkpoint inhibitor. The patient experienced a rapid onset of hyperglycemia and DKA after several cycles of Envafolimab, consistent with the pattern of diabetes induced by immune checkpoint inhibitors (ICIs). Notably, the absence of diabetes-related autoantibodies suggests that the diabetes was induced by the immune-modulating effects of Envafolimab rather than a pre-existing autoimmune condition. Management required intensive insulin therapy and a multidisciplinary approach to stabilize the patient’s health. This case underscores the critical need for heightened clinical awareness and early intervention in managing severe immune-related adverse events (irAEs) associated with novel ICIs like Envafolimab. The complexity of autoimmune-related adverse events, such as the negative autoimmune profiles observed in our patient, emphasizes the importance of multidisciplinary collaboration to optimize patient outcomes. We advocate for the establishment of long-term follow-up plans, including regular monitoring for potential irAEs and endocrine function assessments, to address the chronicity of conditions post-ICI treatment. Recognizing the limitations of current understanding, there is a clear call for further research, particularly on identifying biomarkers that may predict adverse reactions to immunotherapy, to guide precision medicine and improve patient safety.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1505195/fullPD-L1envafolimabtype 1 diabetes mellitusdiabetic ketoacidosisimmune checkpoint inhibitorhepatocellular carcinoma |
| spellingShingle | Youjia Li Kai Qu Xiuli Li Xin Yang Kanghuai Zhang Jiao Xie Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma Frontiers in Immunology PD-L1 envafolimab type 1 diabetes mellitus diabetic ketoacidosis immune checkpoint inhibitor hepatocellular carcinoma |
| title | Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| title_full | Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| title_fullStr | Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| title_full_unstemmed | Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| title_short | Case report: A case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| title_sort | case report a case of type 1 diabetes with diabetic ketoacidosis induced by envafolimab treatment in hepatocellular carcinoma |
| topic | PD-L1 envafolimab type 1 diabetes mellitus diabetic ketoacidosis immune checkpoint inhibitor hepatocellular carcinoma |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1505195/full |
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