Immune checkpoint inhibitor therapy-induced autoimmune polyendocrine syndrome type II and Crohn’s disease: A case report

Table 1 Results of laboratory investigations in the emergency room

Investigation	Value	Reference range
Blood gas analysis
pH	7.008	7.35 to 7.45
base excess (mmol/L)	-26.2	-3 to 3
lactic acid (mmol/L)	3.7	0.4 to 2.2
Blood biochemical analysis
Blood glucose (mmol/L)	62.09	3.89 to 6.11
Blood potassium (K+, mmol/L)	5.58	3.5 to 5.5
Blood sodium (Na+, mmol/L)	124	137 to 147
Serum creatinine (µmol/L)	207.8	20.0 to 98.0
Urea nitrogen (BUN, mmol/L)	18.03	1.7 to 7.5
Creatine kinase (U/L)	343	24 to 195
Amylase (IU/L)	854	40 to 132
C-reactive protein (mg/L)	24.24	0.00 to 6.00
Routine blood test
White blood cell count (109/L)	6.7	3.5 to 9.5
Neutrophils (109/L)	3.7	1.8 to 6.3
Red blood cell count (1012/L)	5.23	4.3 to 5.8
Platelet count (109/L)	255	125 to 350
Urinalysis
Urine gravity	1.015	1.006 to 1.030
pH	5	5.5 to 8
Protein	1+	Negative
Urine sugar	4+	Negative
Urinary ketone body	4+	Negative

Table 2 Mixed meal test

Time (min)	BG (mmol/L)	Insulin (µIU/mL)	C-peptide (0.78-5.19 ng/mL)	3 mo later C-peptide
0	15.36	10.9 (2.5 to 9.4)	< 0.01	< 0.01
60	25.89	6.6 (11.9 to 43.5)	< 0.01	< 0.01
120	26.99	5.6 (8.7 to 29.7)	< 0.01	< 0.01

BG: Blood glucose.

Table 3 Thyroid function tests

Investigation	On admission	2 wk later	3 mo later	Reference range
T3 (nmol/L)	1.57	1.14	2.25	0.89 to 2.45
T4 (nmol/L)	191.37	128.27	132.69	62.68 to 150.84
TSH (µIU/mL)	< 0.01	0.01	3.84	0.35 to 4.94
FT3 (pmol/L))	5.27	3.87	4.71	2.63 to 5.71
FT4 (pmol/L)	24.1	16.27	10.91	9.1 to 19.24
TPO-Ab (IU/mL)	> 1000.00	> 1000.00	363	0 to 5.61
TG-Ab (IU/mL)	226.08	140.84	218	0 to 4.11

TSH: Thyroid stimulating hormone; TPO: Thyroid peroxidase; TG: Thyroglobulin.