Wechsler B, Michel J P, Molle D, Wechsler J, Franceschini P, Liozon F, Godeau P
Ann Dermatol Venereol. 1981;108(1):23-30.
The authors report the case of a 22-year-old Guatemalan in whom lupus was diagnosed 8 months after a second pregnancy. The diagnosis of lupus met the criteria of the ARA: Raynaud's syndrome, alopecia, arthralgia, thrombophlebitis, facial erythema, antinuclear factor at 1/100, Farr at 75 p. 100 and immunofluorescent demonstration of IgM binding in healthy skin. Two months after the beginning of the lupus, there was onset of insulin-resistant ketosic diabetes without overweight. The serum insulin was 1.140 mu U/ml. Acanthosis nigricans was noted and confirmed by a biopsy. Insulin-resistance can be attributed to anti-membrane receptor antibodies titrating at 1/200 (R. Khan). The short-term progress of the disease was favorable on corticosteroid treatment. Insulin could be stopped, but high insulin serum levels persisted. This case meets criteria for type B as defined by Flier, Khan and Roth, and is the first European case of lupus with a complete presentation. Short-term progress was favorable, and there is no evidence to affirm that there will be a tardive progression towards hypoglycemia which is, however, possible due to the persistence of elevated serum insulin levels.
作者报告了一例22岁危地马拉女性的病例，该患者在第二次怀孕8个月后被诊断为狼疮。狼疮的诊断符合美国风湿病学会（ARA）的标准：雷诺氏综合征、脱发、关节痛、血栓性静脉炎、面部红斑、抗核因子为1/100、Farr试验为75%、在健康皮肤中有IgM结合的免疫荧光显示。狼疮发病两个月后，出现了无超重的胰岛素抵抗性酮症糖尿病。血清胰岛素为1.140微单位/毫升。发现有黑棘皮病，并经活检证实。胰岛素抵抗可归因于抗膜受体抗体滴定度为1/200（R. Khan）。疾病的短期进展在皮质类固醇治疗下较为良好。胰岛素可以停用，但血清胰岛素水平仍持续升高。该病例符合Flier、Khan和Roth所定义的B型标准，是欧洲首例有完整表现的狼疮病例。短期进展良好，且没有证据证实会出现迟发性低血糖进展，不过，由于血清胰岛素水平持续升高，这种情况是有可能发生的。
