Abstract
BackgroundFulminant type 1 diabetes is characterized by an intrinsic insulin deficiency resulting from the severe destruction of pancreatic β cells and it rapidly leads to ketoacidosis. However, the association between fulminant type 1 diabetes in pregnancy and specific viral infections has not been reported.Case presentationThe patient in this study was a 31-year-old Japanese woman, and at 30 weeks of pregnancy she was admitted with marked fatigue. Fetal bradycardia was noted, and the child was delivered by emergency cesarean section but was stillborn. The maternal blood sugar level was high (427 mg/dL), but the glycated hemoglobin value was 6.2%; therefore, fulminant type 1 diabetes was suspected. Serum antibody testing confirmed a Coxsackievirus B1 infection. The patient in this case had fulminant type 1 diabetes in pregnancy associated with Coxsackievirus B1.ConclusionThis case highlights that fulminant type 1 diabetes in pregnancy may be associated with Coxsackievirus B1 infection.
Highlights
Fulminant type 1 diabetes (FT1D) is a subtype of type 1 diabetes (T1D); it is characterized by the abrupt onset of insulin-deficient hyperglycemia and ketoacidosis within a few days [1].The specific etiology and pathogenesis of FT1D are unclear and may be related to genetic predisposition, autoimmunity, viral infection, and pregnancy.Viral infection is strongly associated with fulminant diabetes, as reported previously, and can be associated with frequent flu-like symptoms along with a seasonal variation in time of onset
We report the case of a patient who developed FT1D in pregnancy accompanied by Coxsackievirus B1 infection
Despite the presence of diabetic ketoacidosis (DKA), the glycated hemoglobin (HbA1c) value was within the normal range (6.2%), and urinary Cpeptide reactivity (CPR) was extremely low at 0.5 μg/day
Summary
Fulminant type 1 diabetes (FT1D) is a subtype of type 1 diabetes (T1D); it is characterized by the abrupt onset of insulin-deficient hyperglycemia and ketoacidosis within a few days [1]. At 30 weeks and 6 days, she was admitted with marked fatigue and dyspnea She did not present with fever, headache, costochondritis, pharyngitis, diarrhea, Hayakawa et al Journal of Medical Case Reports (2019) 13:186 maculopapular non-pruritic rash, nausea, or flu-like symptoms such as a sore throat, cough, or rhinorrhea. She was diagnosed as having DKA due to FT1D She was simultaneously treated with fluid replacement and continuous insulin infusion to maintain vital signs, plasma glucose, and electrolyte levels. Paired serum antiviral antibody test To investigate the association between viral infection and FT1D, we performed serological testing for several viruses such as parainfluenza virus 1–3, Coxsackievirus A2–7, 9, 10, 16, B1–6, cytomegalovirus (CMV), Epstein– Barr virus (EBV), and human herpes virus (HHV) 6 at day 3, day 17, and day 38 (Table 2). CMV cytomegalovirus, EBNA Epstein–Barr virus nuclear antigen, EBV Epstein–Barr virus, HHV human herpes virus, VCA viral capsid antigen
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