1996 Volume 39 Issue 10 Pages 803-808
The case of a 66-year-old woman with acute onset IDDM is reported. In October 1993, she experienced headache and fever and visited a nearby hospital for treatment. However, her symptoms were not relieved, and two weeks later she experienced diabetic ketoacidosis and was admitted to Kawasaki Medical School Hospital. Her serum was positive for antinuclear antibodies and contained a high level of antibody against the EB virus (EBV) capsid antigen. She exhibited eosinophilia and was flomoxef positive in the lymphocyte-stimulating test. Many atypical (nontuberculous) mycobacteria were cultured from her stool and sputum. HLA typing results were A: 3/24 (9);B: 44 (12)/61 (40);Cw: 5/-, DR: 1/6, DQ: 1/-. Anti-islet cell antibody and the islet cell surface antibody were both negative. Uric C-peptide immunoreactivity (CPR) was less than 1μg/day for the whole period of hospitalization except for a few days. The glucagon test was negative at plasma CPR.
The best conjecture as to the etiology in this case was EBV infection. This case was also considered rare because it was suggested that the atypical mycobacterial infection was caused by malnutrition, and that it changed the sensitivity of immunological activity.
