Journal List > Endocrinol Metab > v.27(4) > 1085979

So, Koo, Cho, Hwang, Ahn, Chung, and Jeong: A Case of Fulminant Type 1 Diabetes Mellitus with Human Leukocyte Antigen DR4-DQ4

Abstract

The clinical characteristics of fulminant type 1 diabetes are abrupt onset of disease, very short (<1 week) duration of diabetic symptoms, ketoacidosis at diagnosis, negativity for islet-related autoantibodies, virtually no C-peptide secretion (fasting plasma C-peptide <0.3 ng/mL), a near normal hemoglobin A1c (HbA1c) level and an elevated serum pancreatic enzyme level. The pathogenesis has not yet been clarified, however the involvement of both genetic background and viral infections has been suggested. We reported a case of fulminant type 1 diabetes. A 37-year-old woman was admitted with stuporous consciousness to our hospital. Four days prior to the admission, she was hospitalized with the diagnosis of acute pancreatitis in another hospital, and at that time her glucose level was 79 mg/dL. Three days after the hospitalization, her state of consciousness became stuporous and she was transferred to our hospital. The laboratory results were as follows: pH 6.94, glucose 1,602 mg/dL, and HbA1c 5.5%. She was negative for islet-related autoantibodies and viral antibodies. HLA haplotypes were DRB1*04:05/*04:06, DQB1*03:02/*04:01 which might be a considerable risk allele for fulminant type 1 diabetes. She was diagnosed with fulminant type 1 diabetes, and has been treated with multiple component insulin regimens.

References

1. Bottazzo GF, Florin-Christensen A, Doniach D. Islet-cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet. 1974. 2:1279–1283.
2. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998. 15:539–553.
3. Imagawa A, Hanafusa T, Miyagawa J, Matsuzawa Y. A proposal of three distinct subtypes of type 1 diabetes mellitus based on clinical and pathological evidence. Ann Med. 2000. 32:539–543.
4. Imagawa A, Hanafusa T, Miyagawa J, Matsuzawa Y. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. Osaka IDDM Study Group. N Engl J Med. 2000. 342:301–307.
5. Imagawa A, Hanafusa T. Pathogenesis of fulminant type 1 diabetes. Rev Diabet Stud. 2006. 3:169–177.
6. Imagawa A, Hanafusa T, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, Shimada A, Shimizu I, Toyoda T, Maruyama T, Makino H. Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care. 2003. 26:2345–2352.
7. Sano H, Terasaki J, Tsutsumi C, Imagawa A, Hanafusa T. A case of fulminant type 1 diabetes mellitus after influenza B infection. Diabetes Res Clin Pract. 2008. 79:e8–e9.
8. Goto A, Takahashi Y, Kishimoto M, Nakajima Y, Nakanishi K, Kajio H, Noda M. A case of fulminant type 1 diabetes associated with significant elevation of mumps titers. Endocr J. 2008. 55:561–564.
9. Kwon JY, Roh MO, Song MS, Jung CH, Park HK, Kim YJ, Mok JO, Kim SJ, Kim CH, Byun DW, Yu MH, Suh KI, Jung JH. A case of fulminant type 1 diabetes mellitus after hepatitis A infection. Korean Clin Diabetes. 2009. 10:118–122.
10. Akatsuka H, Yano Y, Gabazza EC, Morser J, Sasaki R, Suzuki T, Fujiwara R, Katsuki A, Takei Y, Sumida Y. A case of fulminant type 1 diabetes with coxsackie B4 virus infection diagnosed by elevated serum levels of neutralizing antibody. Diabetes Res Clin Pract. 2009. 84:e50–e52.
11. Tanaka S, Kobayashi T, Momotsu T. A novel subtype of type 1 diabetes mellitus. N Engl J Med. 2000. 342:1835–1837.
12. Shimada A, Morimoto J, Kodama K, Oikawa Y, Irie J, Nakagawa Y, Narumi S, Saruta T. T-cell-mediated autoimmunity may be involved in fulminant type 1 diabetes. Diabetes Care. 2002. 25:635–636.
13. Shimada A, Oikawa Y, Shigihara T, Senda T, Kodama K. A case of fulminant type 1 diabetes with strong evidence of autoimmunity. Diabetes Care. 2002. 25:1482–1483.
14. Miura Y, Suzuki A, Sato I, Kato Y, Oiso Y. A case of fulminant type 1 diabetes with graves' disease. Diabetes Care. 2002. 25:1894–1895.
15. Sakaue S, Nagata M, Wakabayashi O, Honda T, Yoshimura H, Yamaguchi E, Nishimura M. A case of fulminant type 1 diabetes with elevated rheumatoid factor and the temporal presence of thyroid-stimulating hormone receptor antibody. Diabetes Care. 2002. 25:935–936.
16. Imagawa A, Hanafusa T, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, Shimada A, Shimizu I, Maruyama T, Makino H. Different contribution of class II HLA in fulminant and typical autoimmune type 1 diabetes mellitus. Diabetologia. 2005. 48:294–300.
17. Taniyama M, Katsumata R, Aoki K, Suzuki S. A Filipino patient with fulminant type 1 diabetes. Diabetes Care. 2004. 27:842–843.
18. Zheng C, Zhou Z, Yang L, Lin J, Huang G, Li X, Zhou W, Wang X, Liu Z. Fulminant type 1 diabetes mellitus exhibits distinct clinical and autoimmunity features from classical type 1 diabetes mellitus in Chinese. Diabetes Metab Res Rev. 2011. 27:70–78.
19. Jung TS, Chung SI, Kim MA, Kim SJ, Park MH, Kim DR, Kang MY, Hahm JR. A Korean patient with fulminant autoantibody-negative type 1 diabetes. Diabetes Care. 2004. 27:3023–3024.
20. Kim MS, Yu KY, Lee SY, Kim SY, Kim SJ, Hwang PH, Lee DY. A case of fulminant type 1 diabetes mellitus with peripheral neuropathy in a Korean child. J Korean Soc Pediatr Endocrinol. 2009. 14:82–84.
TOOLS
Similar articles