Goto Atsushi, Takahashi Yoshihiko, Kishimoto Miyako, Nakajima Yoshifumi, Nakanishi Koji, Kajio Hiroshi, Noda Mitsuhiko
Department of Diabetes and Metabolic Medicine, International Medical Center of Japan, Tokyo, Japan.
Endocr J. 2008 Jul;55(3):561-4. doi: 10.1507/endocrj.k07e-126. Epub 2008 Jun 3.
Type 1 diabetes mellitus is classified as either autoimmune or idiopathic. Fulminant type 1 diabetes was originally reported as a subtype of idiopathic type 1 diabetes. Though involvement of viral infections has been suggested as a triggering mechanism, its pathogenesis remains unknown. Here, we present a case of fulminant type 1 diabetes associated with significant elevation of mumps titers. A 56-year-old Japanese man had suffered from nausea and generalized fatigue for two days before being transferred to our hospital in a confused state. Findings on admission revealed a high blood glucose level, near-normal HbA1c level, metabolic acidosis, and increased urinary ketone levels. Serum tests for islet-associated autoantibodies were negative. The serum, urinary C-peptide levels and the result of glucagon test indicated severe impairment of insulin secretion. These results were compatible with the diagnosis of fulminant type 1 diabetes. Also, he was suspected as having mumps infection on the basis of serological testing. These findings suggest that fulminant type 1 diabetes developed after mumps virus infection in our case. To the best of our knowledge, no other report has indicated an association between a recent mumps infection and the onset of fulminant type 1 diabetes. This case suggests an association between fulminant type 1 diabetes and mumps virus infection.
1型糖尿病分为自身免疫性或特发性。暴发性1型糖尿病最初被报道为特发性1型糖尿病的一种亚型。尽管有人提出病毒感染参与其中是一种触发机制，但其发病机制仍不清楚。在此，我们报告一例与腮腺炎抗体滴度显著升高相关的暴发性1型糖尿病病例。一名56岁的日本男性在以意识模糊状态被转送至我院前两天出现恶心和全身乏力。入院检查发现血糖水平高、糖化血红蛋白（HbA1c）水平接近正常、代谢性酸中毒以及尿酮水平升高。胰岛相关自身抗体的血清学检测结果为阴性。血清和尿C肽水平以及胰高血糖素试验结果表明胰岛素分泌严重受损。这些结果与暴发性1型糖尿病的诊断相符。此外，根据血清学检测怀疑他感染了腮腺炎。这些发现提示在我们的病例中暴发性1型糖尿病是在腮腺炎病毒感染后发生的。据我们所知，没有其他报告指出近期腮腺炎感染与暴发性1型糖尿病的发病之间存在关联。该病例提示暴发性1型糖尿病与腮腺炎病毒感染之间存在关联。
