Anti‐programmed death ligand 1 therapy‐induced type 1 diabetes presenting with multiple islet‐related autoantibodies

Anti-programmed death ligand 1 therapyinduced type 1 diabetes presenting with multiple islet-related autoantibodiesAn immune-related adverse event is a new disease entity that occurs after the introduction and extensive use of anticancer immune agents, such as anti-programmed cell death protein 1 (PD-1) or anti-programmed death ligand 1 (PD-L1) antibodies.Anti-PD-L1-related type 1 diabetes is the immune-related adverse event that typically presents as fulminant type 1 diabetes, characterized by an absence of anti-islet autoantibodies.We are presenting a case of anti-PD-L1 therapy-related type 1 diabetes with highly positive anti-GAD and anti-islet antigen 2 antibodies.The present patient was a 66-year-old Japanese men with type 2 diabetes diagnosed at the age of 57 years.Since then, he had been treated with nateglinide, teneligliptin and biphasic insulin aspart 30.He was diagnosed with squamous cell lung carcinoma in the right lower lobe at the age of 63 years.His lung cancer was initially treated with concurrent chemotherapy and radiation therapy.After a recurrence, the anti-PD-L1 antibody, atezolizumab, was introduced at the age of 64 years.Although his biopsied lung cancer tissue specimens showed negative PD-L1 expression, the atezolizumab had been effective.The diameter of the primary nodule changed from 43 to 34 mm.Two months after starting atezolizumab, his glycated hemoglobin level rapidly increased from 7.8 to 10.0%.The serum C-peptide level, which was 4.3 ng/mL 1 year earlier, became undetectable.However, no obvious ketosis and no

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