Two cases of immune checkpoint inhibitor-associated diabetes mellitus induced by serplulimab: Case reports
Year: 2025
Type: article
Study design: Case Report
Abstract: RATIONALE: Immune checkpoint inhibitors have shown promising efficacy in treating various malignancies; however, their use is associated with immune-related adverse events, including rare but severe immune checkpoint inhibitor-induced diabetes mellitus (ICI-DM). Serplulimab-induced ICI-DM has been rarely reported, and its clinical presentation can be heterogeneous. PATIENT CONCERNS: We report 2 patients with small cell lung cancer who developed serplulimab-induced ICI-DM, both complicated by diabetic ketoacidosis (DKA). Case 1 developed delayed-onset ICI-DM after 2 years of treatment, with elevated glycated hemoglobin and moderate C-peptide deficiency. Case 2 developed ICI-DM earlier, with severe insulin deficiency and classic type 1 diabetes features. Neither patient tested positive for diabetes-related autoantibodies. DIAGNOSES: Both patients were diagnosed with serplulimab-induced ICI-DM, confirmed by hyperglycemia, C-peptide deficiency, and DKA during ongoing programmed cell death protein 1 inhibitor therapy. INTERVENTIONS: Standard DKA management was administered for both patients. They were transitioned to subcutaneous insulin therapy and continued serplulimab treatment under close glucose monitoring. OUTCOMES: Both patients' DKA was successfully controlled. They continued serplulimab and insulin therapy after discharge, with no recurrence of acute DKA. LESSONS: These cases highlight the clinical heterogeneity and diagnostic challenges of ICI-DM. Routine blood glucose and glycated hemoglobin monitoring before and during immunotherapy may aid early detection. Clinicians should maintain a high index of suspicion for ICI-DM, even in patients without typical risk factors. Early recognition and insulin initiation are essential to prevent life-threatening complications of DKA. This report contributes to the limited literature on serplulimab-induced ICI-DM and provides practical insights into its diagnosis and management.
Source: Medicine
Authors: Yuan Gao, Meiyuan Lin, Jun Deng
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4415526186