Acute onset of type 1 diabetes accompanied by acute hepatitis C: the potential role of proinflammatory cytokine in the pathogenesis of autoimmune diabetes.
A 22-year-old Japanese woman presented with general fatigue. Five days later, she demonstrated a body temperature of 39 degrees C and a loss in weight of 5kg. She thereafter became unconscious and was taken to Tomakomai City General Hospital. Urinary ketone body was positive, and plasma glucose was 1063mg/dl. The serum asparate aminotransferase and alanine aminotransferase levels were 158 and 1220IU/l, respectively. An arterial blood gas analysis showed metabolic acidosis. Glycated hemoglobin was 10.9%. Urinary C-peptide immnoreactivity was 11microg/day. Anti-glutamic acid decarboxylase antibody was 12.4U/ml. In general, islet-associated autoantibodies are detectable several years before the development of overt autoimmune diabetes, thus suggesting that an autoimmune reaction against beta-cells had already started in this case. On viral examinations, hepatitis C virus (HCV) antibody was negative, while HCV-RNA was positive. Based on these findings, she was diagnosed to have autoimmune diabetes and acute hepatitis C. In addition, her serum interleukin-18 level was elevated to 506pg/ml. The duration of diabetic characteristic symptoms before diagnosis is usually several weeks in most cases of autoimmune diabetes. However, it was extremely short in this case. Taken together, these findings suggested that the progression of autoimmune diabetes might have been accelerated due to the infection of HCV.
Masuda
Hajime
H
Department of Internal Medicine, Tomakomai City General Hospital, 1-2-21 Honko-cho, Tomakomai 053-8567, Japan. h-masuda@tonan.gr.jp
Atsumi
Toshiya
T
Fujisaku
Atsushi
A
Shimizu
Chikara
C
Yoshioka
Narihito
N
Koike
Takao
T
D000328:Adult; D001784:Blood Gas Analysis; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D016207:Cytokines / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000097:blood / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D016896:Treatment Outcome; D015431:Weight Loss
D016207:Cytokines; D003404:Creatinine