Severe Insulin Resistance with Diabetic Ketoacidosis After Brentuximab Treatment

OBJECTIVE: To increase awareness of unusual inflammatory and other responses including severe insulin resistance (IR) associated with the use of targeted immunotherapies such as brentuximab. METHODS: We report the case of a man without any previous diagnosis of diabetes who developed diabetic ketoacidosis complicated by severe IR (unresponsive to >600 units of intravenous insulin per hour) after receiving brentuximab for Hodgkin lymphoma. RESULTS: Autoantibodies to the insulin receptor were not detected in the patient's serum, thus excluding a diagnosis of type B IR. CONCLUSION: We hypothesize that brentuximab administration led to a rare reaction leading to systemic cytokine release with extreme IR in our patient.