title: Efficacy of oral glucocorticoid and cyclosporine in a case of rituximab-refractory type B insulin resistance syndrome.
abstract: We describe a case of type B insulin resistance syndrome associated with systemic lupus erythematosus (SLE) that was refractory to rituximab and successfully treated with a combination of oral glucocorticoids and cyclosporine. Prior to treatment, insulin resistance was severe, and application of a hyperinsulinemic euglycemic clamp was not possible despite the continuous intravenous infusion of insulin at a maximum rate of 9.0 mU/kg/min. The addition of cyclosporine to oral glucocorticoid therapy resulted in remission of insulin resistance. The combination of oral prednisolone and cyclosporine might be effective in treating type B insulin resistance syndrome, particularly in rituximab-resistant cases. However, nephrotoxicity is a particular concern for patients receiving long-term cyclosporine therapy.
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takei
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kato
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sekido
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine Matsumoto, Nagano, Japan.
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Komatsu
keywords: Cyclosporine; Systemic lupus erythematosus; Type B insulin resistance syndrome