A Case of Fulminant Type 1 Diabetes With Elevated Rheumatoid Factor and the Temporal Presence of Thyroid-Stimulating Hormone Receptor Antibody
- Shinji Sakaue, MD1,
- Megumi Nagata, MD1,
- Osamu Wakabayashi, MD1,
- Toshiro Honda, MD2,
- Haruhiko Yoshimura, MD1,
- Etsuro Yamaguchi, MD1 and
- Masaharu Nishimura, MD1
- 1First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan
- 2Department of Internal Medicine, Konan Hospital, Sapporo, Japan
Type 1 diabetes is divided into two subtypes: autoimmune and idiopathic diabetes (1). Recently, fulminant type 1 diabetes was identified as a novel subtype of idiopathic diabetes (2). Imagawa et al. (2), who first identified this subtype, hypothesized that the disorder is caused by nonautoimmune mechanisms, including viral infection of exocrine pancreatic tissue. This hypothesis was generated from the negative test results for diabetes-related antibodies in patients with fulminant type 1 diabetes.
Additional pieces of supporting evidence were the absence of hyperexpression of major histocompatibility complex class I molecules in islets and the presence of lymphocyte infiltration in exocrine pancreatic tissue without insulitis in …
