Diagnostic Dilemma: Clinical and Histological Abnormalities in a Hispanic Patient With Diabetes

Abstract

The review of organ donors’ medical history is often limited to the terminal hospitalization records. This 32-year-old Hispanic patient had a history of type 1 diabetes since age 13 years and was treated with insulin since diagnosis. However, we have reasons to challenge the clinical diagnosis. The HLA region provides the highest contribution to genetic risk for type 1 diabetes (2). Although the HLA profile observed for this patient is not known to be associated with either risk or protection (2,3), there has been a recent rise in type 1 diabetes incidence among patients with HLA considered to confer lower risk for developing the disease (4). The absence of type 1 diabetes–associated autoantibodies (i.e., glutamic acid decarboxylase, insulinoma-associated protein 2, zinc transporter 8) at the time of study may be attributable to autoantibody loss over time; the absence altogether has been reported in …