Abstract
A possible link between viral infections such as mumps, Coxsackie B4 virus and congenital rubella and juvenile diabetes mellitus has been suggested. However, juvenile diabetes mellitus following acquired rubella infection has not been reported. A case of juvenile diabetes mellitus with myocarditis following rubella infection is reported. A 17-yr-old male patient whose father had suffered from diabetes mellitus, was admitted to Kanazawa University Hospital. He complained of weight loss (3 kg/2 months) and thirst, with accompanying hyperglycemia (fasting blood glucose level was 260 mg/100 ml), glycosuria and ketonuria, 2 months after rubella infection. Rubella infection was diagnosed from the typical skin rash, low grade fever and epidemic occurrence of similar symptoms among students at the Senior High School. It was confirmed by a rubella HI titer reduction from 562 to 256 in 4 months. On diet treatment alone, the ketonuria disappeared and urinary g lucose excretion decreased from 147 g/day to 2 g/day. Diurnal variations in blood glucoselevels, 50 g oral glucose tolerance test pattern and the responses of plasma C-peptide immunoreactivity to 100g glucose-glucagon-tolbutamide improved. The diabetic state of the patient was controlled by diet and 6 units of NPH insulin/day. Two weeks after admission, his ECG showed negative T waves in H, III and aVF, which were normalized in 6 months, suggesting viral myocarditis. It is conceivable that the diabetic state of the present patient was attributable to reversible insulitis following rubella infection.
