Hepatic injury and diabetic ketoacidosis induced by tislelizumab
10.3760/cma.j.cn114015-20230911-00669
- VernacularTitle:替雷利珠单抗致肝损伤和糖尿病酮症酸中毒
- Author:
Yazhi WANG
1
;
Fangfang DUAN
1
;
Yue LI
1
;
Song YANG
1
Author Information
1. 首都医科大学附属北京地坛医院肝病中心，北京 100015
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Esophageal neoplasms;
Chemical and drug induced liver injury;
Diabetic ketoacidosis;
Tislelizumab
- From:
Adverse Drug Reactions Journal
2024;26(1):50-52
- CountryChina
- Language:Chinese
-
Abstract:
A 63-year-old female patient with esophageal cancer received tislelizumab monotherapy (intravenous infusion of 200 mg once every 21 days) after surgery. The patient had no disease history of chronic liver disease or diabetes mellitus. At day 39 after the fourth cycle of tislelizumab treatment, abnormal liver function was found, with alanine aminotransferase 494 U/L, aspartate aminotransferase 442 U/L, alkaline phosphatase 1 161 U/L, and total bilirubin 21.4 μmol/L. Then no further tislelizumab was given. After excluding liver injury caused by other reasons through liver pathological examination and relevant laboratory tests, it was considered to be related to tislelizumab. After giving methylprednisolone (32 mg/d orally) and liver protective treatments, the patient's liver function was gradually improved. After 2 weeks of treatment, the dose of methylprednisolone was reduced to 16 mg/d, and 2 weeks later, the patient's fasting blood glucose rose to 19.4 mmol/L. The dose of methylprednisolone was reduced to 8 mg/d. After 2 days, the blood glucose rose to 33.7 mmol/L, blood lactate 3.66 mmol/L, and urinary ketone (++++). Diabetic ketoacidosis was diagnosed and methylprednisolone was discontinued. The fasting and 2-hour postprandial serum insulin and C-peptide levels were significantly reduced, suggesting the damage of pancreatic islet function. Type 1 diabetes caused by tislelizumab was considered. After treatments such as insulin supplement and correcting acidosis, the patient's liver function was improved. At 8 months of follow-up, the patient's liver function returned to normal, but long-term insulin supplement was needed to control blood glucose.
