A Case of Steroid-Induced Diabetes Mellitus Associated with Diabetic Ketoacidosis, Painless Acute Pancreatitis, Abdominal Aortic Thrombosis, and Renal Infarction

Abstract

A 65-year-old man administrated prednisolone for arthralgia from June 21, 2008, experienced thirst, polydipsia, and polyuria, then impaired consciousness on August 10. Conscious level was JCS I-2. Laboratory studies showed blood sugar of 1023 mg/dl and high blood, urine ketone body count. Blood gas analysis showed pH of 7.269 and base excess of -20 mmol/l. He was diagnosed with diabetic ketoacidosis (DKA) and hospitalized on the same day. Acidosis and hyperglycemia improved with intravenous fluid administration and continuous insulin injection. Serum amylase and lipase were markedly elevated the next day, but no abdominal symptoms were noted. He was diagnosed with acute pancreatitis, abdominal aortic thrombosis, and right renal infarction based on abdominal computed tomography. Non-per-oral and gabexate mesilate treatment were initiated for acute pancreatitis and anticoagulant therapy for thrombosis and renal infarction. He had no stomachache during the clinical course. Nine month after discharge, he underwent a 75-g oral glucose tolerance test and the result was normal.