Systemic Toxicity With Hyperglycemia or Diabetic Ketoacidosis After Enfortumab Vedotin: Single-Center Case Series
Enfortumab vedotin (EV) revolutionized management of metastatic urothelial carcinoma. Multiple-organ dysfunction is a rare adverse event associated with EV with unknown mechanisms. We report three cases of unusual EV systemic toxicity with hyperglycemia and/or diabetic ketoacidosis (DKA) shortly after EV administration. The first case demonstrated insulin-resistant DKA requiring large doses of insulin, high C-peptide levels consistent with intact pancreatic β-cell function, cutaneous eruption, and fatal hemodynamic shock. The second case presented with hyperglycemia, symmetrical muscle weakness, and diffuse cutaneous eruption. The third consisted of mild DKA, rash, jaundice, and confusion. We discuss these severe presentations and empirical therapeutic approaches.
Authors
- Woo Cheal Cho (ORCID: https://orcid.org/0000-0001-5867-1403)
- Omar Alhalabi (ORCID: https://orcid.org/0000-0002-9658-2206)
- Matthew T. Campbell (ORCID: https://orcid.org/0000-0003-1915-4491)
- Nupur Kikani (ORCID: https://orcid.org/0000-0003-3790-3927)
- Jonathan L. Curry (ORCID: https://orcid.org/0000-0003-0630-6222)
- Sonali Thosani (ORCID: https://orcid.org/0000-0002-4149-3572)
- Mouhammed Amir Habra (ORCID: https://orcid.org/0000-0002-4148-9637)
- Meenakshi B. Bhattacharjee (ORCID: https://orcid.org/0000-0001-7556-9988)
- Arlene O. Siefker‐Radtke (ORCID: https://orcid.org/0000-0002-6328-9599)
- Nathaniel R. Wilson (ORCID: https://orcid.org/0000-0002-9123-1781)
- Anisha B. Patel (ORCID: https://orcid.org/0000-0002-5372-784X)
- Anindita Ghosh (ORCID: https://orcid.org/0000-0002-4391-1811)
- Mohammad Jad Moussa (ORCID: https://orcid.org/0009-0000-7960-8614)
Institutions
- The University of Texas MD Anderson Cancer Center (US)
- University of Michigan (US)
- The University of Texas Health Science Center at Houston (US)
Publication Details
- Journal
- Annals of Internal Medicine Clinical Cases
- Published
- 2025-05-01
- DOI
- https://doi.org/10.7326/aimcc.2024.0465
- Primary Topic
- Botulinum Toxin and Related Neurological Disorders
- Type
- article
- Field-Weighted Citation Impact
- 0.00