[Fatigue and icterus in a 27-year-old patient with diabetes mellitus type I].
We report about a 27-year-old female with type I diabetes who was admitted with progressive fatigue and a sudden onset of icterus. As the underlying cause, we found pernicious anemia with hemolytic activity as part of polyglandular autoimmune syndrome (PAS) type II. Under vitamin B(12) substitution we saw a quick rise in hemoglobin and improvement of complaints. Type I diabetes is the most frequent component of PAS II, whereas pernicious anemia is a rather rare component; however, a latent form is seen in about 12% of patients with type I diabetes. Therapy for pernicious anemia consists of parenteral vitamin B(12) substitution. Because of an increased incidence of gastric cancer in chronic atrophic gastritis, endoscopic follow-ups of the chronic atrophic autoimmune gastritis seem to be recommended. Due to the diverse characteristic of PAS II, with development of additional components after years of latency, regular follow-up clinical examinations and lab work are mandatory to detect further need of hormone and vitamin replacement that may sometimes be substantial for survival.
Bösch
D
D
Medizinische Klinik I, Klinikum Bremerhaven, Reinkenheide, Bremerhaven. boesch@atem-online.de
Kurtz
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W
D000328:Adult; D000752:Anemia, Pernicious / Q000175:diagnosis* / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1; D005221:Fatigue / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000175:diagnosis / Q000517:prevention & control*; D016884:Polyendocrinopathies, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy*; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome
D012256:Riboflavin