2012 Volume 55 Issue 8 Pages 638-644
We report on a 74 years old woman with type 1 diabetes mellitus complicated with Sjögren's syndrome, primary biliary cirrhosis, systemic sclerosis, idiopathic thrombocytopenic purpura and megasigmoid. She had been diagnosed as having diabetes mellitus at the age of around 55 and insulin treatment was started at around 65. At 72 years old, she suffered from diabetic ketoacidosis and at that time was diagnosed as having volvulus of the sigmoid colon. We diagnosed her having slowly progressive type 1 diabetes mellitus because of very low serum and urinary C-peptide levels and elevated anti-GAD antibodies. Clinical and laboratory findings revealed that she also had Sjögren's syndrome, primary biliary cirrhosis and systemic sclerosis. At 74 years old, she suffered from obstructive ileus due to dilatation of the sigmoid colon, and underwent an operation. Resection specimens showed reduction of Auerbach's plexus and Meissner's plexus, and thinning and fibrotic change of the muscle layer. At 9 days after the operation, she developed idiopathic thrombocytopenic purpura. Although type 1 diabetes mellitus is sometimes complicated with other autoimmune diseases, the complication with Sjögren's syndrome, primary biliary cirrhosis, systemic sclerosis and idiopathic thrombocytopenic purpura has not been reported. Furthermore, the present case demonstrated the reduction of Auerbach's plexus and Meissner's plexus of megasigmoid, which is also an interesting observation suggesting the influence of diabetic neuropathy and that of autoimmune disorders.
