AME Case Reports最新文献

{"title":"Failure of the tyrosine kinase inhibitors osimertinib and erlotinib to manage a patient with EGFR-mutant lung adenocarcinoma: a case report.","authors":"Malik W Z Khan, Muhammad Ahmad, Salma Qudrat, Long Tu, Salman Khan, Ekrem Yetiskul, Samra Iftikhar","doi":"10.21037/acr-24-122","DOIUrl":"https://doi.org/10.21037/acr-24-122","url":null,"abstract":"<p><strong>Background: </strong>Lung adenocarcinoma, a type of non-small cell lung cancer (NSCLC), is the most common type of lung cancer among non-smokers. Lung adenocarcinoma in exon 19 deletion (E19del) mutation-positive cases respond well to treatment with tyrosine kinase inhibitors (TKIs). Our case demonstrates the development of resistance to first- and third-generation TKIs in a 48-year-old woman with epidermal growth factor receptor (EGFR) mutation-positive advanced NSCLC.</p><p><strong>Case description: </strong>A 48 years old woman with no smoking history and no family history of cancer was diagnosed with EGFR mutation-positive advanced lung adenocarcinoma. Molecular analysis indicated a positive EGFR E19del mutation and a positive T790M mutation, and after two rounds of chemotherapy, the patient was treated with osimertinib for 2 years. However, the patient started to experience recurring chest discomfort, dyspnea, insomnia, and bone pain while being treated. A whole-body computed tomography (CT) scan at that time revealed metastasis of the tumor to the paraaortic lymph nodes and lumbar spine. A repeat analysis revealed that the T790M mutation had disappeared while other mutations remained unchanged, and she was switched to erlotinib as per the evidence for the use of erlotinib in osimertinib-resistant lung cancer. The patient developed cutaneous adverse reactions and, although her symptoms subsided initially for 6 months, she developed morning headaches and worsening insomnia. A repeat magnetic resonance imaging (MRI) revealed metastasis to the frontal and occipital lobes of her brain, indicating failure of erlotinib treatment.</p><p><strong>Conclusions: </strong>Resistance development to TKIs poses a significant challenge to the treatment of EGFR mutation-positive advanced lung adenocarcinoma, owing to the scarce availability of further pharmacological agents post-TKIs. This case illustrates the significance of prompt recognition of resistance to erlotinib and osimertinib and highlights the importance of further research to prevent treatment failure and hence, to deter metastatic progression of the tumor in patients with advanced NSCLC.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"53"},"PeriodicalIF":0.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PIK3CA inhibitor treatment for metastatic scrotal extramammary Paget's disease: a case report and literature review.","authors":"Yuanqiong Huang, Siying Dong, Jianqing Ren, Jinyan Li, Chenwang Wu, Hongbo Chen, Yujie Liu, Jia Yuan, Jun Huang, Lin Xiao","doi":"10.21037/acr-24-170","DOIUrl":"https://doi.org/10.21037/acr-24-170","url":null,"abstract":"<p><strong>Background: </strong>Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma that occurs in the genitals, axilla, and anus, where apocrine sweat glands are abundant. This disease is mainly characterized by localized lesions and rare distant metastasis. Scrotal Paget's disease is a rare type of EMPD, and there is no standard treatment for metastatic EMPD.</p><p><strong>Case description: </strong>Here, we reported the genetic results of a patient with a <i>PIK3CA</i> gene mutation in scrotal Paget's disease who developed multiple metastases to the lymph nodes, liver, and bones during adjuvant radiotherapy, as well as the results of treatment with a PIK3CA inhibitor. The latest advances in this field were also summarized. The treatment response was evaluated as stable disease (SD) after 6 courses of docetaxel plus tegafur (DS regimen) chemotherapy. Then, a second-line treatment, a PIK3CA inhibitor, WX390, was administered with tolerable toxicity. There was a treatment-induced increase in blood glucose level during treatment, and insulin was administrated with good control. The progression-free survival (PFS) was 3.9 months and the overall survival (OS) was 16 months.</p><p><strong>Conclusions: </strong><i>PIK3CA</i> is a commonly mutated gene in EMPD. To the best of our knowledge, this is the first case report of a PIK3CA inhibitor for the treatment of primary metastatic EMPD, and the treatment efficacy was good. PIK3CA inhibitors may be promising for the treatment of metastatic EMPD in the future.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"47"},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare etiology of acute abdomen: a falciform ligament necrosis case report.","authors":"Hugo Steyaert, Nour Kassab, Abdelilah Mehdi, Sorin Cimpean","doi":"10.21037/acr-24-168","DOIUrl":"https://doi.org/10.21037/acr-24-168","url":null,"abstract":"<p><strong>Background: </strong>Falciform ligament necrosis (FLN) is a rare and challenging condition often presenting with nonspecific symptoms resembling more common abdominal pathologies.</p><p><strong>Case description: </strong>Here, we present a case of a 61-year-old male, admitted to emergencies with severe abdominal pain and one episode of vomiting. The patient initially diagnosed with mild acute pancreatitis and probable cholecystitis. Because of its severe clinical picture, the patient was admitted to our intensive car unit. Subsequent imaging revealed progression to gangrenous cholecystitis. Decision was taken to drain the gallbladder under computed tomography (CT) scan. Despite antibiotic therapy, the patient developed acute respiratory distress syndrome (ARDS), necessitating intubation. Upon stabilization, an exploratory laparoscopy revealed infected necrosis of the falciform ligament, prompting resection and drainage. Postoperatively, the patient presented a progressive clinical and biological amelioration. The drain was removed and the follow-up was uneventful. A laparoscopic cholecystectomy was scheduled 3 months later.</p><p><strong>Conclusions: </strong>FLN poses diagnostic challenges due to its nonspecific symptoms and tendency to mimic other abdominal pathologies. Diagnostic laparoscopy emerges as a valuable tool for both confirmation and treatment, enabling necrotic tissue excision and effective drainage. This case underscores the importance of considering rare entities like FLN in the differential diagnosis of abdominal acute pain, with laparoscopic intervention offering a definitive therapeutic option.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"60"},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy and lactation-related osteoporosis associating multiple vertebral fragility fractures treated with romosozumab: a case report.","authors":"Hiroshi Nomura, Shigeharu Nomura","doi":"10.21037/acr-24-163","DOIUrl":"https://doi.org/10.21037/acr-24-163","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy- and lactation-related osteoporosis (PLO) is a rare condition of skeletal fragility affecting women during late pregnancy and early lactation. Patients with PLO who experience multiple, rapid-onset vertebral fractures and develop kyphosis face a poorer prognosis when diagnosis and treatment are delayed. Since there is no standard treatment protocol for patients with PLO, treatment should be individually planned. Recently, romosozumab has been recognized as one of the most effective drugs for treating patients with severe osteoporosis. Because it can dramatically increase bone mineral density (BMD) in a short period in postmenopausal women with osteoporosis, it is useful for treating patients with rapidly progressive osteoporosis at a high risk of fracture. Here, we report a case of PLO associated with multiple vertebral fractures treated with romosozumab. To the best of our knowledge, this is the first report on the use of romosozumab alone for PLO.</p><p><strong>Case description: </strong>A middle-aged postpartum and lactating woman experienced back pain at 9 months of pregnancy, which worsened after delivery. PLO was diagnosed based on multiple thoracic vertebral and sacral fragility fractures and low BMD. She was treated with romosozumab, and her back pain gradually subsided. After 12 months of romosozumab treatment, her lumbar spine BMD increased by 22.1% from baseline, and no further fractures occurred.</p><p><strong>Conclusions: </strong>Twelve months of romosozumab treatment successfully improved the clinical condition of the patient with severe PLO, resulting in a remarkable increase in BMD.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"68"},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-onset damage from occupational asbestos exposure: case report.","authors":"Chaïmaâ Zeroual, Merieme Benzakour, Mina Moudatir, Khadija Echchilali, Safaâ Mourabit, Leïla Barakat, Hassan El Kabli","doi":"10.21037/acr-24-164","DOIUrl":"https://doi.org/10.21037/acr-24-164","url":null,"abstract":"<p><strong>Background: </strong>Retroperitoneal fibrosis (RPF), also known as Ormond's disease, is a rare condition characterized by fibrosis in the retroperitoneal space, affecting structures such as the kidneys, ureters, subrenal portion of the abdominal aorta, and the inferior vena cava. While idiopathic RPF is the most common form, it is crucial to rule out secondary causes, which may include certain medications, neoplasms, infections, surgical interventions, or environmental exposures. Prolonged occupational exposure to asbestos is recognized as a rare yet significant cause of RPF.</p><p><strong>Case description: </strong>We present the case of a 64-year-old male patient from Casablanca with no notable medical history who reported right low back pain without accompanying fever and exhibited signs of a deteriorating general condition. Clinical examination revealed tenderness upon palpation of the right flank and a left thyroid nodule. Ultimately, a diagnosis of RPF secondary to prolonged occupational asbestos exposure was established. The patient underwent the insertion of a right JJ stent and received combined corticosteroid therapy.</p><p><strong>Conclusions: </strong>RPF is a chronic condition with management protocols that remain largely undefined, particularly for cases secondary to prolonged occupational asbestos exposure. In benign forms of RPF, corticosteroid therapy serves as the cornerstone of treatment. However, clinicians often find it necessary to incorporate immunosuppressants to prevent frequent relapses associated with tapering or discontinuing corticosteroid therapy. Our initial experience with azathioprine (AZA) has shown promising results.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"66"},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent afatinib and stereotactic body radiotherapy in patient with oligometastatic <i>EGFR</i>-mutated non-small cell lung cancer: a case report and literature review.","authors":"Lisi Sun, Dan Tao, Yuyu Lv, Chunyu Wang, Yue Xie, Wei Zhou","doi":"10.21037/acr-24-174","DOIUrl":"https://doi.org/10.21037/acr-24-174","url":null,"abstract":"<p><strong>Background: </strong>Epidermal growth factor receptor (<i>EGFR</i>)-mutated patients treated with target therapy are inevitable to develop resistance to tyrosine kinase inhibitors (TKIs). It has been proved that concurrent stereotactic body radiotherapy (SBRT) and the first-generation TKIs can prolong both progression-free survival (PFS) and overall survival (OS) of <i>EGFR</i>-mutated patients with limited metastases. However, the efficacy and safety of concomitant second-generation TKIs and SBRT is still unknown.</p><p><strong>Case description: </strong>We for the first time present a stage IVA patient with mutation of both <i>EGFR</i> G719X and L861Q, who after initial response, had developed intracranial progression during afatinib monotherapy. With local treatment for the brain metastasis, she continued to receive afatinib and then a concurrent consolidative lung SBRT. Until January 2023, the patient had achieved a PFS of 24 months and OS of 32 months without serious adverse events except for a grade 1 radiation pneumonitis after the lung SBRT.</p><p><strong>Conclusions: </strong>With this case and a literature review, we aim to demonstrate that concurrent afatinib and consolidative SBRT can bring prognostic benefits to oligometastatic NSCLC patients with uncommon <i>EGFR</i> mutations with good tolerance. However, larger studies with longer follow-up, including randomized controlled trials, are needed to better define the response rates, survival outcomes, and toxicity profiles of this combined therapy. Additionally, further research is required to determine the optimal timing for introducing SBRT in conjunction with afatinib.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"50"},"PeriodicalIF":0.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic myeloid leukemia in a patient treated with palbociclib and exemestane: a case report.","authors":"Lishan Xu, Lu Gan, Shuai Song","doi":"10.21037/acr-24-224","DOIUrl":"https://doi.org/10.21037/acr-24-224","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common type of cancer among women worldwide. Hormone receptor-positive (HR⁺), human epidermal growth factor receptor 2-negative (HER2^-) breast cancer constitutes the predominant subtype, accounting for approximately 70% of all breast cancer cases. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, in conjunction with endocrine therapy (ET), have been used as the standard treatment for patients diagnosed with HR⁺ advanced breast cancer. The hematological adverse effects associated with CDK4/6 inhibitors include leukopenia, neutropenia, anemia, and thrombocytopenia, but the incidence of hematological malignancies following treatment with these agents remains relatively rare.</p><p><strong>Case description: </strong>In this study, we present a case of a 71-year-old woman who was diagnosed with metastatic breast cancer and subsequently developed chronic myeloid leukemia (CML) following her treatment regimen with palbociclib and exemestane. In response to this new diagnosis, the patient commenced therapy with imatinib mesylate while discontinuing palbociclib and receiving exemestane alone for breast cancer. After three months of diligent therapy with imatinib, chronic myeloid leukemia was effectively managed, which permitted the reintroduction of palbociclib at a reduced dosage.</p><p><strong>Conclusions: </strong>This case underscores the pressing need for further research to enhance our understanding of the adverse events associated with treatment using CDK4/6 inhibitors, particularly concerning their effects on the hematological system. Additionally, it highlights the significance of long-term monitoring in clinical practice for patients receiving therapy with CDK4/6 inhibitors.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"64"},"PeriodicalIF":0.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized treatment of pregnancy-associated breast cancer: a report of two cases and literature review.","authors":"Yuanliang Wang, Yu Wang, Suhong Sun","doi":"10.21037/acr-24-223","DOIUrl":"https://doi.org/10.21037/acr-24-223","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-associated breast cancer (PABC) occurs during the special physiological period of female pregnancy, requiring a clinical approach that considers both the effectiveness of maternal treatment and the safety of the baby, creating a clinical challenge. This article discusses the diagnosis and treatment of two PABC cases and provides a thorough review of existing literature to offer insights for clinical practice.</p><p><strong>Case description: </strong>Patient A, a 41-year-old female at 30 weeks and 2 days of gestation, was diagnosed with left breast invasive carcinoma. Following one cycle of AC regimen chemotherapy, she successfully delivered a female infant at 35 weeks and 5 days of gestation. Subsequently, she received 5 cycles of THP regimen neoadjuvant therapy after childbirth. Then, she underwent left breast-conserving surgery and left axillary lymph node dissection. Postoperative pathology indicated pathologic complete response. Post-surgery, she received radiotherapy and targeted therapy. Patient B, a 33-year-old female at 27 weeks and 1 day of gestation, was diagnosed with left breast ductal carcinoma in situ (DCIS). She underwent left total mastectomy with left sentinel lymph node biopsy. Pathology post-surgery revealed intermediate-grade DCIS of the left breast concomitant with locally non-special type invasive carcinoma. No tumour metastasis was identified in the left sentinel lymph node. At 36 weeks of pregnancy, she delivered a male infant and subsequently received 4 cycles of AC regimen chemotherapy. After completing the chemotherapy, a newly formed mass was discovered in her right breast. Right breast mass mastectomy with vacuum assisted biopsy system was performed. Intraoperative pathology indicated intermediate-grade intraductal papillary carcinoma. During surgery, she underwent right total mastectomy and sentinel lymph node biopsy. Intraoperative frozen section analysis revealed the absence of tumour spread in the sentinel lymph nodes (0/8). Postoperatively, she received systematic endocrine therapy.</p><p><strong>Conclusions: </strong>Both patients had successful outcomes for the unborn babies following delivery. By prioritizing the safety of both the mother and the child, tailored breast cancer treatments were given to the two individuals, leading to effective therapy. Clinicians should increase their awareness and knowledge of PABC to avoid misdiagnosis or overlooking diagnoses.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"69"},"PeriodicalIF":0.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted partial gastrectomy with Billroth I anastomosis for gastric plexiform fibromyxoma in children: the first case report and literature review.","authors":"Zhihua Ye, Jixiao Zeng, Huizhen Lu, Fei Liu, Xiaogang Xu, Yuanyuan Luo, Hong Zhang, Menglong Lan, Boyuan Tao, Zijian Liang, Lini Wen","doi":"10.21037/acr-24-214","DOIUrl":"https://doi.org/10.21037/acr-24-214","url":null,"abstract":"<p><strong>Background: </strong>Plexiform fibromyxoma (PF) is an extremely rare mesenchymal tumor, which was first reported by Takahashi <i>et al.</i> in 2007 and named by the World Health Organization (WHO) in 2010 in the classification of digestive system tumors. Currently, only 123 cases have been reported globally, and complete surgical resection is the only effective treatment. On October 20, 2023, we successfully performed a robot-assisted partial gastrectomy with Billroth I anastomosis to remove gastric PF. Since the operation, the child has recovered well. After literature search and novelty confirmation, it was confirmed to be the first case globally (novelty confirmation number: 44011120230247C). Based on this, we reviewed relevant literature and summarized the surgical experience of this case.</p><p><strong>Case description: </strong>A 7-year-old Chinese female patient was admitted to Guangzhou Women and Children's Medical Center in October 2023. Due to \"pallor for 4 months and the discovery of a tumor in the gastric antrum over 2 weeks ago\", an enhancement CT scan revealed a mass in her gastric antrum, approximately 4.0 cm × 3.5 cm × 3.0 cm in size, but its nature remains to be determined. On electronic gastroscopy, a mass was identified in the gastric antrum and pylorus orifice. It exhibited a smooth surface, with its base located on the lesser curvature side and pylorus. We did robot-assisted partial gastrectomy with Billroth I anastomosis for her to remove the mass. Now it has been 11 months after the operation, and the child has recovered well with no sign of mass recurrence.</p><p><strong>Conclusions: </strong>This study confirms that the robot-assisted partial gastrectomy with Billroth I anastomosis for the treatment of gastric PF in children is safe and feasible, and there are no complications of the operation.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"70"},"PeriodicalIF":0.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: pembrolizumab-induced acute type 1 diabetes mellitus and diabetic ketoacidosis in a perioperative esophageal squamous cell carcinoma patient.","authors":"Jicheng Xiong, Jialong Li, Ziwei Wang, Simiao Lu, Shuoming Liang, Wenguang Xiao, Yongtao Han, Xuefeng Leng","doi":"10.21037/acr-24-159","DOIUrl":"https://doi.org/10.21037/acr-24-159","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitor (ICI) therapy rarely results in severe immune-related adverse events (irAEs). Autoimmune diabetes, an uncommon but serious irAE, can be life-threatening if not promptly treated. Although ICIs have been widely used in cancer therapy, there have been no reported cases in China of autoimmune diabetes developing during the perioperative treatment of esophageal squamous cell carcinoma (ESCC). This case report provides a significant clinical contribution by presenting the first documented instance of such an occurrence, emphasizing the need for vigilance and appropriate management strategies.</p><p><strong>Case description: </strong>We present a 52-year-old male with locally advanced stage III locally advanced lower thoracic ESCC who developed type 1 diabetes mellitus (DM1) leading to diabetic ketoacidosis (DKA) after pembrolizumab treatment. The patient had no prior history of diabetes mellitus. He initially presented with progressive dysphagia and underwent two cycles of chemo-immunotherapy with albumin paclitaxel, carboplatin, and pembrolizumab as neoadjuvant therapy, followed by maintenance pembrolizumab after minimally invasive esophagectomy. Following the fifth course, he was admitted to the hospital in a comatose state and quickly diagnosed with DKA. Hemoglobin A1c (HbA1c) was 7.3%, and fasting C-peptide and insulin assays were significantly low. Detailed blood glucose levels and HbA1c were monitored before pembrolizumab initiation, and pre-treatment levels were normal. Pathological examination confirmed a moderately differentiated ESCC with no signs of metastatic disease. The patient received prompt multidisciplinary treatment and has been under follow-up for 10 months with no recurrence of ESCC but requiring ongoing management of diabetes.</p><p><strong>Conclusions: </strong>In summary, this case highlights the rare but potentially life-threatening risk of autoimmune diabetes following pembrolizumab therapy in ESCC patients. The unique clinical contributions of this case include identifying the onset of DM1 during the perioperative period and emphasizing the importance of early detection of DKA symptoms. Clinicians should remain vigilant for such irAEs, ensuring regular monitoring of blood glucose and thyroid function in patients undergoing ICI therapy. Further research is needed to clarify the pathogenesis of pembrolizumab-induced diabetes and develop guidelines for monitoring and managing these adverse events in ESCC patients.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"61"},"PeriodicalIF":0.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}