\u00aa 2010 Asian Association for the Study of Diabetes and Blackwell Publishing

ª 2010 asian association for the study of diabetes

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ª 2010 Asian Association for the Study of Diabetes and Blackwell Publishing Asia Pty Ltd Journal of Diabetes Investigation Volume 1 Issue 6 December 2010 287 Fulminant type 1 diabetes caused by EBV
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reported to possibly be associated with the onset of type 1 diabetes 11–13 . Imagawa et al. 14 found elevated enterovirus IgA antibody titers in patients with fulminant type 1 diabetes and suggested enteroviruses might play a significant role in the onset of diabetes. A possible relationship between the onset of typical type 1A diabetes and viral infection has been suggested for Table 2 | Laboratory data on 18 days after admission and other examinations related to diabetes mellitus, HLA-DNA typing and viral titers Hematological analysis Blood chemistry WBC 9940/ l L AST 103 IU/L BUN 5.9 mg/dL RBC 245 · 10 4 / l L ALT 230 IU/L Cre 0.35 mg/dL Hb 8.4 g/dL c -GTP 468 IU/L TP 5.2 g/dL Hct 25.6% T-Bil 2.7 mg/dL Alb 2.6 g/dL Plt 22.8 · 10 4 / l L ALP 1233 IU/L CRP 2.62 mg/dL Stab 7.0% LDH 402 IU/L Na 128 mEq/L Seg 40.0% CHE 122 IU/L K 4.9 mEq/L Lym 12.0% T-Cho 126 mg/dL Cl 9.5 mEq/L Mono 3.0% TG 93 mg/dL FPG 451 mg/dL Eos 37.0% T-AMY 339 IU/L HbA 1c 6.4 % Baso 1.0% P-AMY 279 IU/L At-lym 0.0% Arterial blood gas analysis pH 7.328 PaCO 2 24.3 mmHg PaO 2 111 mmHg HCO 3 12.4 mmol/L BE ) 11.7 mmol/L Auto-antibody associated islet of the pancreas Virus titers GAD Ab <0.3 U/mL HHV-6 IgM 1:10 ( ) ) IA-2 Ab <0.4 U/mL HHV-6 IgG 1:80 (+) ICA (–) HSV-1 IgM (AU) 0.38 ( ) ) HLA-DNA typing HSV-1 IgG (AU) 76.9 (+) HLA-A A2–A24 VZV IgM (AU) 0.29 ( ) ) HLA-B B35–B67 VZV IgG (AU) 14 (+) HLA-DR DR15–DR16 Rubella virus IgM (AU) 0.25 ( ) ) DRB1 1501–1602 Rubella virus IgG (AU) 9.5 (+) DQB1 0502–0602 Insulin secretion DQA1 0102 Urinary C-peptide (24-hour urine collection) 2.0 l g/day Serum C-peptide (6 min after glucagon 1 mg loaded) £ 0.03 ng/mL BE, base excess; CHE, cholinesterase; FPG, fasting plasma glucose; GAD Ab, glutamic acid decarboxylase antibody; HbA 1c ,hemaglobin A 1c ; HHV-6, human herpes virus-6; HSV-1, herpes simplex herpes-1; IA-2 Ab, insulin autoimmune-2 antibody; ICA, islet cell antibody; T-amy, total amylase; T-Cho, total cholesterol; TG, triglyceride; VZV, varicella zoster virus. (a) (b) Figure 2 | Clinical and pathological features of the patient. (a) Multi- form erythema in the legs and (b) the lesion gradually changed into livedo. The right upper one indicates edematous change in the upper dermis (hematoxylin–eosin stain; magnification: · 40). The right below one reveals an infiltration by lymphocytes and eosinophils in the dermis (hematoxylin–eosin stain; magnification: · 400). 288 Journal of Diabetes Investigation Volume 1 Issue 6 December 2010 ª 2010 Asian Association for the Study of Diabetes and Blackwell Publishing Asia Pty Ltd Fujiya et al.
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several years. A case with possible involvement of EBV at the onset of disease has also been reported. In this case, the HbA 1c level was markedly high (15.8%) at onset and the GAD antibody titer rose later, thereby indicating acute-onset disease. This report was published only in Japanese ( Journal of the Japan Diabetes Society 2003; 46 : 393–397). In our case, EBV anti-VCA IgG and EBV anti-EBNA IgG were already positive at the onset of acute hepatopathy (Figure 1; lower column), thereby suggest- ing the patient had already been infected with EBV. After the
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