Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-8563, Japan.
Endocr J. 2011;58(7):553-7. doi: 10.1507/endocrj.k11e-007. Epub 2011 May 7.
This report presents the case of a 47-year-old female patient with fulminant type 1 diabetes mellitus and myocarditis. Following a high fever, nausea, vomiting and diarrhea, diabetic ketoacidosis occurred and she was transferred to the hospital. The plasma glucose level was 63.6 mmol/L and HbA1c was 7.0%. C-peptide was undetectable in her plasma. Blood gas analysis showed a pH of 6.99. Antibodies to glutamic acid decarboxylase nor insulinoma associated antigen-2 were not detected. She was diagnosed to have fulminant type 1 diabetes mellitus. Her electrocardiogram showed diffuse ST-segment elevations on the second day of admission, along with a positive troponin test. However coronary angiography revealed neither occlusion nor stenosis of the cardiac arteries. An endomyocardial biopsy revealed hypertrophic cardiomyocytes with a disarrangement of myofibers and the focal accumulation of mononuclear cells in the stroma, thus suggesting myocarditis or mild myocarditic change. Viruses are an important cause of myocarditis and the preceding flu-like symptoms indicate the association of viral infection with myocarditis in this case. The mechanisms by which fulminant type 1 diabetes mellitus occurs is still uncertain, but the presence of islet injury accompanied by myocardial inflammation in the current case suggested that a viral infection accounted for the onset of this type of diabetes.
本报告介绍了一例 47 岁女性暴发性 1 型糖尿病伴心肌炎患者的病例。该患者高热、恶心、呕吐、腹泻后发生糖尿病酮症酸中毒，转入我院。其血浆葡萄糖水平为 63.6mmol/L，HbA1c 为 7.0%。血浆 C 肽检测不到。血气分析 pH 值为 6.99。谷氨酸脱羧酶抗体和胰岛素瘤相关抗原-2 抗体均为阴性。诊断为暴发性 1 型糖尿病。患者入院第二天心电图显示弥漫性 ST 段抬高，肌钙蛋白检测阳性。但冠状动脉造影未见心脏动脉闭塞或狭窄。心肌活检显示心肌细胞肥大，肌纤维排列紊乱，间质局灶性单核细胞聚集，提示心肌炎或轻度心肌炎改变。病毒是心肌炎的重要病因，本例发病前有流感样症状，提示病毒感染与心肌炎有关。暴发性 1 型糖尿病的发病机制尚不清楚，但本例胰岛损伤伴心肌炎症提示病毒感染导致了这种类型的糖尿病。
