Modarelli Rachel, Brown Lauren, Boyd Jenny, Podd Bradley, Willis Zachary, Levenson Amy
Division of Pediatric Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Division of Pediatric Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
SAGE Open Med Case Rep. 2023 Jul 31;11:2050313X231190004. doi: 10.1177/2050313X231190004. eCollection 2023.
The initial presentation of pediatric diabetes is variable, making prompt diagnosis and treatment challenging. The overlap between type 1 and type 2 diabetes and presence of developmental delays can complicate diagnosis, resulting in delays and severe illness at presentation. Here we describe a case of a 13-year-old male with autism and attention deficit hyperactivity disorder who presented with severe diabetic ketoacidosis, multiple organ failure, and shock. Within 2 weeks of this initial presentation, he had further clinical decompensation due to an intestinal perforation. Cultures from resected gastrointestinal tissue grew mucormycosis, protracting his hospital stay and recovery. He was able to go home several months later with remarkable improvement. This case highlights the necessity of careful history taking and early testing, and how investigation for rare complications of diabetes is vital when patients do not improve as expected.
儿童糖尿病的初始表现多种多样，这使得及时诊断和治疗具有挑战性。1型和2型糖尿病之间的重叠以及发育迟缓的存在会使诊断复杂化，导致就诊时延误和病情严重。在此，我们描述一例患有自闭症和注意力缺陷多动障碍的13岁男性病例，该患者出现了严重的糖尿病酮症酸中毒、多器官功能衰竭和休克。在首次就诊后的2周内，他因肠穿孔出现了进一步的临床失代偿。切除的胃肠道组织培养出毛霉菌病，延长了他的住院时间和康复时间。几个月后，他显著好转，得以出院。该病例强调了仔细询问病史和早期检测的必要性，以及当患者未按预期好转时，对糖尿病罕见并发症进行调查的重要性。
