Abstract
A 49-year-old woman was admitted after kidney transplantation to treat severe pneumonia. She had undergone hemodialysis due to IgA nephropathy for 4 years. At the age of 42, she underwent renal transplantation with a kidney from her brother. Her transplanted kidney was rejected in Jan. 2008 despite steroid pulse therapy and additional immunosuppression. In mid-March she suffered respiratory failure. During pneumonia treatment, she suffered diabetic ketoacidosis (DKA) on hospital day 33. Plasma glucose was 840 mg/dl, HbA1c 6.4%, pH 7.384, and serum amylase and lipase concentration elevated. Glucagon stimulation test showed no response of serum C-Peptide. Neither ICA nor anti-GAD antibody was detected. Based on these findings, she was diagnosed with fulminant type 1 diabetes mellitus. Cytomegalovirus antigenemia was detected by direct immunoperoxidase using a peroxidase-labeled monoclonal antibody in the serum at DKA onset. Cytomegalovirus IgG titer elevation was confirmed with pair serums before and after DKA. Cytomegalovirus reactivation during immunosuppression therapy may thus participate in destroying pancreatic β-cells.
