A Case of Fulminant Type 1 Diabetes With Strong Evidence of Autoimmunity
- Akira Shimada, MD, PHD1,
- Yoichi Oikawa, MD1,
- Toshikatsu Shigihara, MD1,
- Tomoko Senda, MD2 and
- Keiichi Kodama, MD12
- 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Keio University School of Medicine, Tokyo, Japan
- 2Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan
We have recently reported (1) that T-cell autoimmunity may be involved in so-called “fulminant” type 1 diabetes (characterized by diabetic ketoacidosis [DKA], low HbA1c level at onset, insulin deficiency, and negative islet-associated autoantibodies), which was originally proposed as a novel subtype of type 1B diabetes (2). In our previous report (1), we found a high serum level of interferon-inducible protein-10 (IP-10), an important chemokine inducing migration of activated T-cells to local lesions (3), and GAD-reactive CD4+ cells in the periphery of a patient, even though no islet-associated antibody was detected.
Here, we report another case of fulminant type 1 diabetes, a 48-year-old man who was proven to have not only a high serum IP-10 level and GAD-reactive CD4+ cells in the periphery but also …
