A Case of Type 1 Diabetes Mellitus Coexisting with Autoimmune Thyroid Disease Occurring 12 Years after Churg-Strauss Syndrome Onset

Abstract

We report an exceedingly rare case of a patient developed type 1 diabetes mellitus together with autoimmune thyroid disease 12 years after the onset of Churg-Strauss syndrome.
A 60-year-old woman who had been operated on for sinusitis at age 33 developed Churg-Strauss syndrome at age 45 with symptoms of generalized numbness, fever, pain and weakness in the lower extremities, difficulty in walking, and eosinophilia and increased IgE in laboratory findings. Remission was achieved after treatment with predonisolone.
At age 57, 12 years after Churg-Strauss syndrome onset, she developed type 1 diabetes mellitus with symptoms of thirst, polyuria, polydipsia, and weight loss, i.e., HbA₁c of 12.8%, GAD antibody of 497 U/ml, and was treated using rapid-acting insulin analog of 38-45 unit/day plus NPH insulin of 10-18 unit/day. A thyroid function test showed hypothyroidism due to chronic (Hashimoto's) thyroiditis, i.e. TSH 297 μIU/ml, free T4 0.43 ng/dl, TPO antibody>50 U/ml, so she was treated with levothyroxine. During two years of insulin therapy, her postprandial serum CPR decreased from 0.92 ng/ml to less than 0.05 ng/ml and GAD antibody decreased from 497 U/ml to 10.1 U/ml. Her human leukocyte antigen (HLA) was A^*2402 and DRB1^*0901-DQB1^*0303. Only one case of type 1 diabetes mellitus occurring during Churg-Strauss syndrome remission has, to our knowledge, been reported in Japan.