Diabetes after SARS-CoV-2 Vaccination

A 43-year-old man who had malignant melanoma (pT3bN1bM0 stage IIIC) received nivolumab treatment (480 mg 1× every 4 wks) 12 months before admission. Fasting plasma glucose level was 94 mg/dL and glycated hemoglobin (HbA1c) 5.6% at treatment initiation. Plasma glucose and HbA1c were tested every 4 weeks. His range of plasma glucose was 90–123 mg/dL and that of HbA1c was 5.4%–5.7% (Figure). Positron emission tomography–computed tomography showed no metastasis or recurrence of the tumor 1 month before admission.

The man received his first SARS-CoV-2 vaccination 35 days before admission. No apparent adverse reactions occurred, except for local pain. The last nivolumab dose was administered 21 days before admission and the second SARS-CoV-2 vaccination 14 days before admission. The next day, he had a slight fever (temperature 37°C), which soon subsided. Thirst, polydipsia, and polyuria appeared 2 days after the second vaccination. He started drinking 3 L of water/day, and his weight decreased by 5 kg over the next 12 days.

Twelve days after the second vaccination, his blood glucose level was 655 mg/dL and his HbA1c 8.0%. Levels of ketone bodies increased; 3-hydroxybutyric acid was 2,813 μmol/L and acetoacetate 1,936 μmol/L. He was urgently admitted to the hospital because of a diagnosis of ICI-associated T1D and marked ketosis.

Laboratory tests at admission showed severely impaired insulin secretion capacity; fasting C-peptide immunoreactivity (CPR) was 0.33 ng/mL, 24-hour urinary CPR 5.74 μg/day and 3.82 μg/day, and ΔCPR during the glucagon load test was 0.03 ng/mL (Table). Tests results for islet-specific autoantibodies against glutamic acid decarboxylase, insulinoma-associated antigen 2, and zinc transporter 8 were negative. Human leukocyte antigen typing identified no specific alleles, including DR4, known to be related to T1D (Table). Blood glucose decreased in response to continuous intravenous administration of insulin and saline. On the second day of hospitalization, we switched from intravenous to subcutaneous injection of insulin. The patient’s blood glucose level was ultimately controlled by intensive insulin therapy (degludec 9 U before dinner and lispro 24 U before breakfast, 5 U before lunch, and 15 U before dinner). Five months after discharge, the patient still requires multiple daily insulin injections for glycemic control.



REFERENCE

Sato T, Kodama S, Kaneko K, Imai J, Katagiri H. Type 1 diabetes mellitus associated with nivolumab after second SARS-CoV-2 vaccination, Japan. Emerg Infect Dis. 2022 Jul [date cited]. https://doi.org/10.3201/eid2807.220127

DOI: 10.3201/eid2807.220127

Original Publication Date: April 25, 2022


 Early Release - Type 1 Diabetes Mellitus Associated with Nivolumab after Second SARS-CoV-2 Vaccination, Japan - Volume 28, Number 7—July 2022 - Emerging Infectious Diseases journal - CDC

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis associate
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral load
Read more