Chen Xing-Yu, Wang Cong, Chen Shizhi, Tian Mingyuan, Wang Xin, Zhang Lili
Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Department of Clinical Laboratory, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Front Pharmacol. 2022 Jul 8;13:884878. doi: 10.3389/fphar.2022.884878. eCollection 2022.
Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes, first proposed by Japanese scholars in 2000. Herein, the functions of the islets are rapidly destroyed. Its pathogenesis is related to viral infection. Most people have been infected with Epstein-Barr virus (EBV), and many people have also suffered from drug hypersensitivity, however, few cases of FT1DM which were caused by both of the two conditions have been reported. Thus, below, we describe one such valuable case. The plasma glucose levels of a 73-year-old man diagnosed with drug-induced dermatitis showed a sudden increase (42 mmol/L) during methylprednisolone therapy. The urine ketone test was positive. The glycated hemoglobin level was 7%, endogenous insulin secretion decreased significantly, and the islet-related autoantibodies were negative. The patient was diagnosed with FT1DM. The lymphocyte EBV-DNA showed high copies numbers. The general condition of the patient improved after symptomatic treatment with insulin. However, the systemic allergic reaction aggravated after the use of iodinated contrast agents, prednisone, and thymic pentapeptide. The re-test for EBV-DNA showed significantly high relative levels, thus indicating the presence of EBV infection. We think that drug hypersensitivity and EBV infection together led to FT1DM in this case. After an indication for multiple daily insulin therapy, the patient's blood glucose was quickly controlled and he was discharged on the 38th-day post-admission. FT1DM is a rare case, however, drug hypersensitivity and EBV infection are not rare in the population. This is a rare case of FT1DM caused by drug hypersensitivity reaction and EBV infection. Through this case report, we emphasize the importance of the relationship between drug hypersensitivity, EBV infection and FT1DM and vigilance for the occurrence of FT1DM among hypersensitive individuals in clinical practice.
暴发性1型糖尿病（FT1DM）是1型糖尿病的一种新亚型，于2000年由日本学者首次提出。在此病中，胰岛功能迅速遭到破坏。其发病机制与病毒感染有关。大多数人曾感染过EB病毒（EBV），也有许多人曾发生药物过敏，然而，由这两种情况共同导致的FT1DM病例报道较少。因此，下面我们描述这样一例有价值的病例。一名73岁被诊断为药物性皮炎的男性患者在接受甲泼尼龙治疗期间血糖水平突然升高（42 mmol/L）。尿酮体检测呈阳性。糖化血红蛋白水平为7%，内源性胰岛素分泌显著减少，胰岛相关自身抗体为阴性。该患者被诊断为FT1DM。淋巴细胞EBV-DNA显示高拷贝数。患者经胰岛素对症治疗后一般情况好转。然而，使用碘化造影剂、泼尼松和胸腺五肽后全身过敏反应加重。EBV-DNA复查显示相对水平显著升高，提示存在EBV感染。我们认为在该病例中药物过敏和EBV感染共同导致了FT1DM。在开始多次每日胰岛素治疗后，患者血糖迅速得到控制，并于入院后第38天出院。FT1DM是一种罕见病例，然而，药物过敏和EBV感染在人群中并不罕见。这是一例由药物过敏反应和EBV感染引起的罕见FT1DM病例。通过本病例报告，我们强调了药物过敏、EBV感染与FT1DM之间关系的重要性，以及临床实践中对过敏个体发生FT1DM的警惕性。
