Drug-induced diabetes: toxicity from the use of PI3Kα inhibitor (Alpelisib)

Abstract

Objective: to highlight the importance of early diagnosis of complications of the metabolic sphere with the use of oral phosphatidylinositol-3 kinase (PI3K) inhibitor, rare such as the hyperosmolar state that occurs in <5%, skin rashes, stomatitis, vomiting , diarrhea and nausea and the most frequent ones such as recurrent hypoglycemia caused by a state of insulin resistance that would occur in almost 80% of patients who comply with treatment. A 69-year-old female patient is presented with a history of infiltrating lobular carcinoma of the left breast ST and cp T2N3aM0 in progression: bone, lung, lymph node and biochemistry with a pathogenic variant in the PIK3CA gene who receives therapy with Alpelisib 300 mg/day and Faslodex 500 mg every 14 days. complies for 15 days, who presents lesions in the oral mucosa that causes dysphagia to solids and liquids, urticarial rash on the trunk and neck, nausea, vomiting, weight loss, generalized weakness and drowsiness. Physical examination: urticarial lesions on the chest and neck, whitish plaque-like lesions on the oral cavity and lips, tachypnea, Kussmaul's breathing and drowsiness. Laboratory: Basal glycemia: 536 mg/dl, pH 7.17, HCO3 9.1, Osmolarity 343, GAP anion 33. Which is compatible with a ketotic hyperglycemic hyperosmolar state associated with drug-induced diabetes: grade 4 toxicity due to the use of oral phosphatidylinositol-3 kinase inhibitor. Conclusion: We demonstrate the clinical importance of maintaining strict glycemic control in patients with the use of oral phosphatidylinositol-3 kinase inhibitor to avoid serious complications secondary to toxicity from this drug.