Abstract
Background. Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus (DM) have been reported frequently in patients with the new corona virus disease — 2019, COVID-19. It has been associated with progressive course and worse outcome. There is scarce data on diabetic ketoacidosis (DKA) in COVID-19 infection. There has been several cases reported on COVID-19 infection precipitating a new diagnosis of type 2 DM (T2DM). However, there is a lack of evidence regarding type 1 DM (T1DM). We report a case of DKA precipitated by COVID-19 in a patient with newly diagnosed T1DM. Recently, case reports and small cross-sectional studies described diabetic patients who develop DKA when infected with COVID-19. The incidence of DKA has been found to be high in patients with T1DM and T2DM admitted to hospital with COVID-19. Case presentation. We present a 29 year-old, previously healthy man with 5 days history of fever, fatigue, vomiting, polydipsia and polyuria. His lab results showed high blood glucose, high anion gap metabolic acidosis and ketonuria diagnostic of DKA. He also tested positive for COVID-19 and his Chest CT was consistent with bilateral COVID 19 pneumonia (ground-glass opacity, consolidation, and crazy-paving pattern). He was successfully managed with intravenous fluids and insulin as per DKA protocol. He required intravenous antibiotics, steroids and oxygenotherapy for COVID-19 pneumonia. He was discharged after 14 days in stable condition. Conclusions. COVID-19 infection can be complicated by DKA and development of DM in previously non-diabetic individuals. It is possible that SARS-CoV-2 may aggravate pancreatic beta cell function and precipitate DKA. Very few cases have been reported in the literature on COVID-19 infection precipitating DKA in a newly diagnosed patient of type 1 diabetes mellitus.
Highlights
The Coronavirus Disease 19 (COVID-19) is an infectious disease caused by a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1].During COVID-19 pandemic, diabetes mellitus (DM) was found to be a risk factor for severe disease and worse outcomes [2]
Binding of angiotensin-converting enzyme 2 (ACE2) by SARS-CoV-2 in COVID-19 may play an important role in the pathogenesis of the disease on one hand and could predispose patients to hyperglycemia and development of Diabetes mellitus (DM) on the other hand
Alcohol abuse and drugs like SGLT-2 inhibitors [9] can precipitate an diabetic ketoacidosis (DKA) episode. The patient in this case report was presented with DKA and newly diagnosed type 1 DM (T1DM) triggered by COVID-19 pneumonia
Summary
The Coronavirus Disease 19 (COVID-19) is an infectious disease caused by a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]. A 29-years old previously healthy man, who was not known to have DM but presented to the emergency department (ED) with fatigue and decrease in activity for 5 days along with generalized body aches and nocturia (about 6– 7 times/night) On admission, his temperature was 38.8 oС. He was tested and confirmed to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He is non-smoker and has no family history of DM. The day after admission he was assisted with oxygen therapy because her saturations fall to 86 % He was managed with 20 litres high flow oxygen and 5 days course of dexamethason 4 mg, two times daily with a gradual decrease of doses. He was recommended to contact his local endocrinologist after four weeks, for the follow up consult
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