We present a female patient without metabolic comorbidities, diagnosed with lung adenocarcinoma, in management with pembrolizumab after the third course of treatment, debuted with diabetic ketoacidosis, requiring management for hyperglycemic crisis and insulin needed. Diabetes mellitus type 1 is diagnosed, to get control of this metabolic complication infrequent in immunotherapy, it is decided to reintroduce pembrolizumab treatment at 200 mg every three weeks in addition to insulin management. At present the patient remains with a partial response after 1 year of diagnosis and continues to be managed with insulin therapy. Given that currently there are no protocols and management guidelines for this entity, a review of the management and the literature is carried out because only 6 reported cases are found, this being the first case reported in Colombia.
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