Open AccessFulminant type 1 diabetes mellitus associated with a reactivation of Epstein–Barr virus that developed in the course of chemotherapy of multiple myeloma
Author(s) -
Fujiya Atsushi,
Ochiai Hiroshi,
Mizukoshi Toshihiro,
Kiyota Atsushi,
Shibata Taiga,
Suzuki Atsushi,
Ohashi Norimi,
Sobajima Hiroshi
Publication year - 2010
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/j.2040-1124.2010.00061.x
Subject(s) - medicine , diabetic ketoacidosis , diabetes mellitus , fulminant , chemotherapy , fulminant hepatic failure , gastroenterology , multiple myeloma , endocrinology , insulin , immunology , transplantation , liver transplantation
A 70‐year‐old woman who was diagnosed with multiple myeloma underwent chemotherapy. Three months after beginning chemotherapy, she was readmitted to the hospital because of fever and hepatopathy. Her elevated Epstein–Barr virus (EBV) antibody levels showed that the hepatopathy was caused by reactivation of EBV. On the 18th hospital day, the levels of fasting plasma glucose (FPG; 451 mg/dL) and pancreatic enzymes were suddenly elevated. Elevation of HbA 1c level (6.4%) was slight, as compared with that of the FPG level. Arterial blood gas analysis showed metabolic acidosis and diabetic ketoacidosis was suspected. The serum C‐peptide level was below the detectable limit both before and after glucagon load, thereby suggesting an insulin‐dependent state. These features were identical to the features for fulminant type 1 diabetes mellitus. The levels of EBV anti‐viral capsid antigen immunoglobulin M decreased, and the clinical course was identical to that associated with reactivation of EBV infection. (J Diabetes Invest, doi: 10.1111/j.2040.1124.2010.00061.x, 2010)