Abstract
Recently, Coxsackie B4 virus (C-B4) infection has been suggested to be one of the causes of diabetes mellitus. In this communication, C-B4 neutralizing antibody titres in sera were determined in 11 patients including two cases (Case 1, Case 2) with acute insulin-dependent diabetes followed by the almost complete remission.
Case 1 is a male subject aged 26. His condition was initially similar to common cold, being accompanied with thirst and acute body weight loss, then he was admitted to our hospital because of diabetic precoma. On admission, his blood glucose concentration was 588mg/dl, plasma IRI 12μU/m/, plasma IRG 440pg/ml (by Unger 30K), and metabolic acidosis was remarkable. After having had some 40 days' insulin treatment, he underwent complete remission with the restoration to approxymately normal fasting blood glucose concentration and O-GTT pattern which have been lasting up to the present time (for more than one and half years) only on the diet therapy. In case 1, C-B4 neutralizing antibody titre showed as high as 128 on admission, rose to more than 256 after 37 days, however, returned to normal after 6 months. Case 2 is a male subject aged 44. He was also admitted to our hospital due to acute diabetes associated with common cold. On admission, his fasting blood glucose concentration was 286mg/dl and he underwent insulin treatment for 40 days, until he could be controlled only by the diet therapy. No abnormal findings were observed thereafter for more than one and half years except slightly decreased glucose tolerance. C-B4 neutralizing antibody titre in case 2 showed 128 on admission, persisting in the same titre, and was normalized in 3 months.
C-B4 neutralizing antibody titres were determined in other 9 with known diabetes; titres were less than 8 in 7 patients, and 32 and 128 in the remaining two.
Case 1 and 2 developed acute insulin deficiency following common cold in parallel with the increased C-B4 neutralizing antibody titres. The diabetic state was proven to be transient, showing 2 to 3 months duration. Therefore, it seems probable that their diabetic state might be attributed to the reversible injury of Langerhans islets by C-B4 infection.
