Fulminant type 1 diabetes associated with Coxsackievirus B4:A report of 2 cases

Abstract

Fulminant type1 diabetes (T1 DM) has recently been identified as a new subtype of idiopathic diabeles, characlerized by rapid development of diabetes with no comorbidity of autoimmunity. Here, we report two cases of patients; each patient was presented with abrupt and extreme hyperglycemia and ketoacidosis without any evidence of previous diabetes mellitus. A 74-years-old man suffered from polydipsia for 2 days. At presentation, his serum C-peptide level was 0.06ng/ml, HbA 1c level was 6.7% and the serum Iipase was elevated. A 21-years-old man had polydipsia for 2 weeks. His serum C-peptide and HbA 1c levels were 0.73ng/ml and 17.6%, respectively. The serum lipase was normal. In both patients, anti-GAD antibody tests were negative, whereas tests for Coxsackievirus B4 virus infection were positive. Furthermore, insulin therapy is needed in both patients to control their blood glucose levels at discharges and during the follow-up period.