Enfortumab Vedotin-Induced Diabetic Ketoacidosis and Acute Tubulointerstitial Nephritis Requiring Intensive Care in the Treatment of Advanced Urothelial Carcinoma: A Case Report.

Introduction: Enfortumab vedotin (EV) has been approved for the treatment of many types of cancer, and its use is still expanding. It is an essential drug used as a standard treatment for advanced and metastatic urothelial carcinoma but is known to cause various adverse events (AEs).

Case presentation: We report a patient with metastatic urothelial carcinoma who experienced multiple AEs associated with diabetic ketoacidosis (DKA) during EV treatment. The onset of DKA during EV treatment has been reported to be associated with poor prognosis. Although strict management was required in the intensive care unit, we were able to save the patient's life.

Conclusion: Although the detailed mechanism that induced insulin resistance remains unclear, the patient required high-dose insulin because of a marked increase in insulin resistance. If hyperglycemia is observed during EV therapy, DKA may lead to the occurrence of serious AEs. We report on the pathogenesis and management of drug-induced DKA caused by EV based on our case and a literature review.