Abstract
The patient was a 51-year-old female. She had developed Graves' disease at the age of 20 years, slowly demonstrated progressive type 1 diabetes at 37 years, and had been followed up while undergoing insulin injection therapy twice/day. She developed diarrhea from June 2008, demonstrated the aggravation of diarrhea and abdominal pain from the middle of October, and frequently showed hypoglycemia unawareness due to a poor appetite. She was referred to our hospital for close examination and treatment. After oral antibiotic administration, no improvement was observed. Colonoscopy showed findings of total-colitis-type ulcerative colitis accompanied by cytomegalovirus infection. Total parenteral nutrition with no oral intake was initiated, and the blood glucose level was controlled by continuous intravenous infusion using an insulin syringe pump and the sliding-scale method. The administration of intravenous ganciclovir injections (14 days) and oral 5-aminosalicylate agents was initiated. Then, 2 courses of steroid pulse therapy were performed. Subsequently, continuous steroid therapy was conducted, and the symptoms gradually improved. The patient tested positive for both anti-GAD antibodies and anti-TPO antibodies, but negative for anti-IA-2 antibodies and TSH-R antibodies. She also had HLA-DR4 which has been recognized as a susceptibility HLA for type 1 diabetes in Japan.
