2020 Volume 63 Issue 4 Pages 188-194
An 83-year-old man developed high fever and systemic edematous erythema after taking mexiletine for 6 weeks. Although the patient then stopped the medicine as directed by a physician, he was hospitalized one week later due to the worsening of his symptoms. On the second day of hospitalization, the patient further developed thirst, polyuria and polyposia, and a blood analysis revealed the following biochemical abnormalities: blood sugar, 1069, mg/dL; HbA1c, 6.1 %, remarkably high blood ketone bodies, and depletion of insulin secretion capacity. Based on these findings, the patient was diagnosed with fulminant type 1 diabetes (FT1D) associated with drug-induced hypersensitivity syndrome (DIHS). Throughout the treatment course, the patient was found to be positive for serum cytomegalovirus (CMV)-DNA from the early stages, and additionally showed a high CMV IgG antibody titer. The patient was also positive for plural pancreatic islet-related autoantibodies, but negative for human herpes virus-6 antibodies. The HLA class II haplotype was DRB1*09: 01-DQB1*03:03. Since CMV may have been related to the pathophysiology of this patient, we believe that reactivation of CMV should be considered when a patient presents with DIHS complicated by FT1D.
