title: Development of fulminant Type 1 diabetes with thrombocytopenia after influenza vaccination: a case report.
abstract: BACKGROUND
  Fulminant Type 1 diabetes was originally reported as idiopathic Type 1 diabetes. Involvement of viral infections in the pathogenesis of fulminant T1D has been suggested, but the development of fulminant Type 1 diabetes after influenza vaccination has not been reported.
  
  
  METHODS
  We report a case of fulminant Type 1 diabetes with thrombocytopenia following influenza vaccination. A 54-year-old man was admitted to hospital with hyperglycaemia and diabetic ketosis. Seven days before admission, he received a seasonal influenza vaccine for the prevention of influenza infection. On admission, blood glucose was 29 mmol/L and HbA1c 40 mmol/mol (5.9%). Fasting and 2-h C-peptide immunoreactivity were <0.0333 nmol/L and 0.0999 nmol/L, respectively. Anti-GAD and anti-IA-2 antibodies were negative, so no autoimmunity seemed to participate in the etiology. ELISPOT assay also showed no association with T cell-mediated autoimmunity. HLA genotypes were consistent with susceptibility to fulminant Type 1 diabetes. After the abrupt onset of diabetes, he showed mild thrombocytopenia, which has been observed for approximately 5 years after diabetes development.
  
  
  CONCLUSIONS
  This is the first description of fulminant Type 1 diabetes after influenza vaccination. Our observation raises the possibility that influenza vaccination might trigger this condition via the TLR7 pathway.
authors.affiliation: Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. yasuda@med.kobe-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Yasuda
authors.forename: M
authors.initials: M
authors.lastname: Nagata
authors.forename: H
authors.initials: H
authors.lastname: Moriyama
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Akisaki
authors.forename: H
authors.initials: H
authors.lastname: Ueda
authors.forename: K
authors.initials: K
authors.lastname: Hara
authors.forename: K
authors.initials: K
authors.lastname: Yokono
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000209:etiology / Q000276:immunology / Q000821:virology; D016883:Diabetic Ketoacidosis / Q000209:etiology* / Q000821:virology; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects*; D007251:Influenza, Human / Q000150:complications* / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000209:etiology* / Q000276:immunology / Q000821:virology; D051199:Toll-Like Receptor 7 / Q000276:immunology
chemical_list: D007252:Influenza Vaccines; D051199:Toll-Like Receptor 7