Abstract
A 55-year-old man visited a general practitioner due to a 3 day history of rigor and elevated temperature. Oral antipyretic medicines were administered. The next day he presented to our hospital with an erythematous skin rash. The patient's blood glucose was 113 mg/dl. On the sixth day the papules and erythematous areas became larger and began to merge. His blood glucose level increased to 200 mg/dl on the seventh day. On the ninth day, no deterioration in hepatic function was found but an abdominal CT scan revealed the significant enlargement of the pancreas, liver, and spleen. The patient complained of increased thirst, polyuria and general fatigue from day 11 and he was transferred to our department on the thirteenth day after the onset of symptoms. He was diagnosed with acute diabetic ketoacidosis. His blood glucose level was 807 mg/dl, his arterial blood pH was 7.285 and he was positive for both urine and blood ketones, however, his HbA1c was 6.9 % and he was negative for autoantibodies. A glucagon loading test showed a decrease but not a complete exhaustion in his insulin secretion at onset. Here, we report a case of fulminant type 1 diabetes-like disease and the details of the patient's pancreatic size, blood glucose levels and insulin secretion in response to a glucagon stimulation test before and after the onset of symptoms.
