Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Diabet Med. 2012 Jan;29(1):88-9. doi: 10.1111/j.1464-5491.2011.03391.x.
Fulminant Type 1 diabetes was originally reported as idiopathic Type 1 diabetes. Involvement of viral infections in the pathogenesis of fulminant T1D has been suggested, but the development of fulminant Type 1 diabetes after influenza vaccination has not been reported.
We report a case of fulminant Type 1 diabetes with thrombocytopenia following influenza vaccination. A 54-year-old man was admitted to hospital with hyperglycaemia and diabetic ketosis. Seven days before admission, he received a seasonal influenza vaccine for the prevention of influenza infection. On admission, blood glucose was 29 mmol/L and HbA1c 40 mmol/mol (5.9%). Fasting and 2-h C-peptide immunoreactivity were <0.0333 nmol/L and 0.0999 nmol/L, respectively. Anti-GAD and anti-IA-2 antibodies were negative, so no autoimmunity seemed to participate in the etiology. ELISPOT assay also showed no association with T cell-mediated autoimmunity. HLA genotypes were consistent with susceptibility to fulminant Type 1 diabetes. After the abrupt onset of diabetes, he showed mild thrombocytopenia, which has been observed for approximately 5 years after diabetes development.
This is the first description of fulminant Type 1 diabetes after influenza vaccination. Our observation raises the possibility that influenza vaccination might trigger this condition via the TLR7 pathway.
暴发性 1 型糖尿病最初被报道为特发性 1 型糖尿病。病毒感染在暴发性 T1D 的发病机制中起作用已被提出，但流感疫苗接种后发生暴发性 1 型糖尿病的情况尚未见报道。
我们报告了一例流感疫苗接种后发生暴发性 1 型糖尿病伴血小板减少症的病例。一名 54 岁男性因高血糖和糖尿病酮症酸中毒入院。入院前 7 天，他接受了季节性流感疫苗接种以预防流感感染。入院时，血糖为 29mmol/L，HbA1c 为 40mmol/mol（5.9%）。空腹和 2 小时 C 肽免疫活性分别<0.0333nmol/L 和 0.0999nmol/L。抗 GAD 和抗 IA-2 抗体均为阴性，因此似乎没有自身免疫参与病因。ELISPOT 检测也表明与 T 细胞介导的自身免疫无关。HLA 基因型与暴发性 1 型糖尿病的易感性一致。糖尿病急性发作后，他出现轻度血小板减少症，在糖尿病发病后约 5 年观察到这种情况。
这是首例流感疫苗接种后发生暴发性 1 型糖尿病的描述。我们的观察结果提示流感疫苗接种可能通过 TLR7 途径引发这种情况。
