Toxic shock syndrome associated with newly diagnosed type I diabetes.
Studies of two post-mortem pancreata of children at the onset of type I diabetes have suggested activation and expansion of islet infiltrating T cells by a superantigen. We present the first reported case of a superantigen mediated disease, toxic shock syndrome (TSS), occurring at the diagnosis of type I diabetes. A 12-year-old girl presented with TSS and newly diagnosed diabetes with ketoacidosis. At presentation she was unconscious, febrile and hypotensive, with a desquamating erythematous rash and Kussmaul breathing. During resuscitation, her renal impairment, diarrhoea, thrombocytopaenia and ketoacidosis resolved. Vaginal discharge and blood cultures grew Staphylococcus aureus. T cell studies at 2 weeks after diagnosis detected a high level of spontaneous and islet antigen-specific proliferation with associated interleukin-10 production compared to human leucocyte antigen DR matched controls.
Couper
J J
JJ
Department of Endocrinology, Women's and Children's Hospital, North Adelaide, Australia. jcouper@medicine.adelaide.edu.au
Kallincos
N
N
Pollard
A
A
Honeyman
M
M
Prager
P
P
Harrison
L C
LC
Rischmueller
M
M
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D012772:Shock, Septic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018089:Superantigens / Q000032:analysis*
D000900:Anti-Bacterial Agents; D007328:Insulin; D018089:Superantigens