Submission Type

Case Report


Introduction: Pembrolizumab (Keytruda®) is a potent and selective humanized monoclonal immunoglobulin antibody that blocks programmed cell death-1 on T cells, augmenting the antitumor immune response. Pembrolizumab is an approved adjuvant therapy for treating metastatic melanoma.

Clinical Findings: A 75-year-old man with metastatic melanoma developed diabetic ketoacidosis before receiving a sixth cycle of pembrolizumab.

Clinical Course: He received intravenous insulin, fluids, and electrolyte repletion per the diabetic ketoacidosis protocol. He presented again to the emergency room with profound hyperglycemia 1 week after discharge. Following a second round of treatment, his home insulin regimen was titrated for better glycemic control, and pembrolizumab was discontinued.

Conclusions: As cases of diabetes associated with immune checkpoint inhibitor therapy are increasingly reported, challenges may include adequately managing diabetes long-term, preventing diabetic ketoacidosis, and discontinuing pembrolizumab due to immune-related adverse effects.



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