A case of chronic hepatitis C developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy.
We report a case of chronic hepatitis C presenting insulin-dependent diabetes mellitus (IDDM) associated with various autoantibodies including possible anti-insulin receptor antibody (AIRA) during interferon (IFN) therapy. A 57-year-old man having chronic hepatitis C virus (HCV) infection with chronic thyroiditis received IFN therapy. The thyroid function was well-controlled by administration of thyroid hormone, although thyroid autoantibodies were positive. At 15 weeks after starting IFN (reaching 530 million units of total dose), marked thirst happened, with increased fasting plasma glucose level (488 mg/dl) and decreased daily urinary C peptide immunoreactivity level (less than 4.2 microg/day). IDDM occurred with anti-nuclear antibody (ANA), anti-DNA antibody and possible AIRA, and thyroid autoantibodies titers increased, but without pancreatic islet cell antibody and anti-glutamic acid decarboxylase antibody. Administration of IFN was stopped and insulin treatment was started, but plasma glucose level was not controlled well. AIRA became negative 2 months later, however, insulin antibody (IA) was positive when tested after 18 months. Serum HCV RNA has been negative, and a normal level of serum transaminase has been observed since IFN therapy. It is likely that IFN therapy induced the immunological disturbance and resulted in occurrence of various autoantibodies and IDDM in the patient.
Uto
H
H
Department of Internal Medicine II, Miyazaki Medical College, Kiyotake 5200, 889-1601, Miyazaki, Japan.
Matsuoka
H
H
Murata
M
M
Okamoto
T
T
Miyata
Y
Y
Hori
T
T
Ido
A
A
Hirono
S
S
Hayashi
K
K
Tsubouchi
H
H
D000974:Antibodies, Antinuclear / Q000097:blood; D000998:Antiviral Agents / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology*; D005968:Glutamate Decarboxylase / Q000276:immunology; D006442:Glycated Hemoglobin / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D007328:Insulin / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000097:blood; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011972:Receptor, Insulin / Q000276:immunology; D011994:Recombinant Proteins; D013963:Thyroid Hormones / Q000627:therapeutic use; D065227:Transfusion Reaction
D000974:Antibodies, Antinuclear; D000998:Antiviral Agents; D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D005968:Glutamate Decarboxylase; D006442:Glycated Hemoglobin; D007328:Insulin; D007330:Insulin Antibodies; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011972:Receptor, Insulin; D011994:Recombinant Proteins; D013963:Thyroid Hormones; C024211:islet cell antibody