Marchese Michael, Leinung Matthew, Shawa Hassan
Division of Endocrinology, Phelps Medical Center, Sleepy Hollow, Albany, NY, USA.
Division of Endocrinology, Albany Medical Center, Albany, NY, USA.
Avicenna J Med. 2017 Apr-Jun;7(2):67-70. doi: 10.4103/ajm.AJM_124_16.
A 43-year-old incarcerated man with AIDS was hospitalized for 30 pounds weight loss and diffuse pruritic rash. Three months prior, he was started on dapsone for pneumonia prevention. Biochemical evaluation was remarkable for eosinophilia, thrombocytopenia, acute renal insufficiency, transaminitis, thyrotoxicosis, and significant hyperglycemia (450 mg/dl; nl, 65-99). His hemoglobin A1c level was 5.9% (nl, 4.1-5.6). Thyroid-stimulating immunoglobulin, glutamic acid decarboxylase, and islet cell autoantibodies were within the normal range. He was found to have acute interstitial nephritis based on renal biopsy. He was diagnosed with hypersensitivity reaction due to dapsone. The patient was managed with a tapering dose of corticosteroid, beta-blocker, and multiple daily injections of insulin. The symptoms and biochemical disturbances including thyrotoxicosis resolved within a few weeks. Insulin requirements decreased but diabetes did not resolve with hemoglobin A1c of 6.1% a year after hospitalization. To our knowledge, this is the first case of hypersensitivity reaction due to dapsone causing simultaneous fulminant type 1 diabetes and thyroiditis.
一名43岁的艾滋病男性在押人员因体重减轻30磅和弥漫性瘙痒性皮疹入院。三个月前，他开始服用氨苯砜预防肺炎。生化检查显示嗜酸性粒细胞增多、血小板减少、急性肾功能不全、转氨酶升高、甲状腺毒症和显著高血糖（450mg/dl；正常范围65 - 99）。他的糖化血红蛋白水平为5.9%（正常范围4.1 - 5.6）。促甲状腺素受体抗体、谷氨酸脱羧酶和胰岛细胞自身抗体均在正常范围内。经肾活检发现他患有急性间质性肾炎。他被诊断为氨苯砜引起的过敏反应。患者接受了逐渐减量的皮质类固醇、β受体阻滞剂治疗，并每日多次注射胰岛素。包括甲状腺毒症在内的症状和生化紊乱在几周内得到缓解。胰岛素需求量减少，但糖尿病未缓解，住院一年后糖化血红蛋白为6.1%。据我们所知，这是首例氨苯砜引起的过敏反应导致同时发生暴发性1型糖尿病和甲状腺炎的病例。
