2008 Volume 51 Issue 11 Pages 1013-1016
A subtype of nonautoimmune type 1 diabetes with rapid-onset diabetic ketoacidosis (DKA), low HbA1c at onset, insulin deficiency, and negative diabetes-related autoantibodies has been proposed as nonautoimmune fulminant type 1 diabetes. A 67-year-old woman admitted with DKA, hyperthyroidism, and upper gastrointestinal hemorrhage had suffered from thirst, nausea, and epigastric pain for 3 days before admission. One day before admission, she was seen elsewhere for repetitive vomiting with coffee-ground emesis and was given medication for upper gastrointestinal symptoms. On the day of admission, she suffered DKA with consciousness disorder. Despite significantly increased plasma glucose, HbA1c was elevated only slightly. Anti-GAD antibody was slightly positive and anti-IA-2 antibody was negative. HLA typing was HLA DR4. These clinical and laboratory findings indicated symptoms of fulminant type 1 diabetes except for the preserved residual insulin-secretion function of the islets of Langerhans, so we diagnosed this case as autoimmune type 1 diabetes. This case is notable because (1) it showed fulminant type 1 diabetes-like clinical onset and (2) it showed acute necrotizing esophagitis, probably because autoimmune type 1 diabetes was complicated by hyperthyroidism at onset.
