Fulminant type 1 diabetes mellitus associated with a reactivation of Epstein-Barr virus that developed in the course of chemotherapy of multiple myeloma.
A 70-year-old woman who was diagnosed with multiple myeloma underwent chemotherapy. Three months after beginning chemotherapy, she was readmitted to the hospital because of fever and hepatopathy. Her elevated Epstein-Barr virus (EBV) antibody levels showed that the hepatopathy was caused by reactivation of EBV. On the 18th hospital day, the levels of fasting plasma glucose (FPG; 451 mg/dL) and pancreatic enzymes were suddenly elevated. Elevation of HbA1c level (6.4%) was slight, as compared with that of the FPG level. Arterial blood gas analysis showed metabolic acidosis and diabetic ketoacidosis was suspected. The serum C-peptide level was below the detectable limit both before and after glucagon load, thereby suggesting an insulin-dependent state. These features were identical to the features for fulminant type 1 diabetes mellitus. The levels of EBV anti-viral capsid antigen immunoglobulin M decreased, and the clinical course was identical to that associated with reactivation of EBV infection. (J Diabetes Invest, doi: 10.1111/j.2040.1124.2010.00061.x, 2010).
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Atsushi
A
Fujiya
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Hiroshi
H
Ochiai
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Toshihiro
T
Mizukoshi
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Atsushi
A
Kiyota
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Taiga
T
Shibata
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Atsushi
A
Suzuki
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Norimi
N
Ohashi
Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan.
Hiroshi
H
Sobajima
Epstein–Barr virus; Fulminant type 1 diabetes mellitus; Multiple myeloma