2020 Volume 63 Issue 7 Pages 451-457
A 53-year-old woman was admitted to our hospital because of central nervous system lupus. She had been diagnosed with systemic lupus erythematosus and begun treatment with immunosuppressive therapy at 46 years old. Because her glucose tolerance had become exacerbated, DPP4 inhibitor therapy was started at 52 years old. After admission, we began steroid pulse therapy and subcutaneous insulin infusion therapy. Insulin resistance was an initial problem (CPR 8.1 ng/mL) hampering her glucose intolerance, but her glycemic control improved gradually. A month after the admission, reactivation of cytomegalovirus occurred. Thereafter, her pancreatic exocrine enzyme level increased, and her pancreatic endocrine function decreased (Amy 1796 U/L, CPR 2.6 ng/mL) concomitant with swelling of the pancreas on computed tomography. Her glycemic control became disturbed once again, so we started intravenous insulin infusion therapy. She had also been receiving antiviral therapy and steroid therapy. Once the reactivation of cytomegalovirus had disappeared, her pancreatic exocrine enzyme levels normalized, and her endocrine function returned to its previous level (Amy 179 U/L, CPR 7.4 ng/mL). We suspected that the infection had spread to her pancreas, but antiviral and continued steroid therapy may have helped reduce the inflammation in her pancreas.
