Abstract
Both local (1) and systemic immediate-type insulin allergy (2) as well as delayed-type cutaneous reactions (3) to human insulin have been reported. Histologically verified Arthus reaction to insulin has only been reported in exceptional cases in which the patient was treated with bovine/porcine insulin (4). To the best of our knowledge, no histologically verified type 3 hypersensitivity reaction has been described in a patient treated with human insulin. We report a case of leucocytoclastic vasculitis in a 48-year-old normal-weight female patient with well-controlled (HbA1c 6.4, upper normal 6.4%) type 1 diabetes since 1984 who had always been treated with ∼0.5 units · kg−1 body wt · day−1 semisynthetic human insulin and, beginning in 1998, recombinant human insulin. The patient did not have microvascular complications (normal fundoscopy, urinary albumin, and vibration perception threshold). She presented October 1997 with monophasic tender indurations at the injection sites of both human regular and NPH insulins (Novo Nordisk) in the abdominal and femoral regions, respectively, with occurrence within 2–6 …
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