Abstract
A 45-year-old woman with thirst and vomiting 10 days before admission, followed by consciousness disturbance and brought to the emergency clinic was found to have plasma glucose of 955 mg/dl and HbA1c of 5.9%, together with markedly increased ketone bodies and serum pancreatic exocrine enzymes. Urinary C-peptide was very low, and she had no GAD antibody-all consistent with fulminant type 1 diabetes. Continuous insulin infusion therapy restored consciousness the next day, but she lost consciousness again 3 days after admission due to hypernatremia. She suffered emphysematous cholecystitis 21 days after admission. Ultrasonagraphy and computed tomography showed gas in the gallbladder, necessitating emergency cholecystectomy. Pathological analysis showed full-thickness infarctive necrosis. Emphysematous cholecystitis is a rare condition caused by ischemia of the gallbladder. This case suggests that emphysematous cholecystitis can be caused by dehydration and anorexia with fulminant type 1 diabetes.
