Fujioka Takahiro, Honda Munehiro, Yoshizaki Tomoyuki, Ogawa Momoko, Matsuno Hisako, Shimokawa Koutaro, Koyama Kazunori
Department of Internal Medicine, Mishuku Hospital, Tokyo.
Intern Med. 2010;49(18):1987-90. doi: 10.2169/internalmedicine.49.3831. Epub 2010 Sep 15.
We report a case of type 1 diabetes onset and recurrence of Graves' disease during pegylated interferon (PEG-IFN)-alpha plus ribavirin treatment for chronic hepatitis C. The patient was a 55-year-old woman diagnosed with chronic hepatitis at age 46 years. She was treated for Graves' disease at 50 years of age. Because Graves' disease remitted, PEG-IFN-alpha plus ribavirin treatment was started for chronic hepatitis C. She was examined because of complaints of general fatigue, weight loss, and palpitations after 24 weeks of the treatment. She was diagnosed with a recurrence of Graves' disease, and methimazole treatment was started. However, she complained of malaise, thirst, polyuria, and loss of body weight. Her fasting blood glucose level was 292 mg/dL and HbA1c was 9.3%. Serum anti-GAD (glutamic acid decarboxylase) antibodies were 2.2 U/mL. She was diagnosed with type 1 diabetes with ketosis, and insulin treatment was started. Serum anti-GAD antibodies gradually increased to 15.1 U/mL. Graves' disease and type 1 diabetes are often complicated, and the coincidental occurrence of these 2 diseases is known as autoimmune polyglandular syndrome type III. However, only a few cases have shown that these diseases occur after IFN treatment.
我们报告了1例在聚乙二醇化干扰素（PEG-IFN）α联合利巴韦林治疗慢性丙型肝炎期间发生1型糖尿病并伴有格雷夫斯病复发的病例。该患者为一名55岁女性，46岁时被诊断为慢性肝炎。她在50岁时接受过格雷夫斯病治疗。由于格雷夫斯病缓解，遂开始用PEG-IFNα联合利巴韦林治疗慢性丙型肝炎。治疗24周后，她因全身乏力、体重减轻和心悸等症状前来就诊。她被诊断为格雷夫斯病复发，并开始使用甲巯咪唑治疗。然而，她又出现了不适、口渴、多尿和体重减轻等症状。她的空腹血糖水平为292mg/dL，糖化血红蛋白（HbA1c）为9.3%。血清抗谷氨酸脱羧酶（GAD）抗体为2.2U/mL。她被诊断为1型糖尿病伴酮症，并开始胰岛素治疗。血清抗GAD抗体逐渐升至15.1U/mL。格雷夫斯病和1型糖尿病常合并存在，这两种疾病同时出现被称为Ⅲ型自身免疫性多腺体综合征。然而，仅有少数病例显示这些疾病发生在干扰素治疗之后。
