A Case of Poorly Controlled Non Insulin Dependent Diabetes Mellitus with Milliary Tuberculosis Under DIC and High Level of ANA

Abstract

A 66-year-old woman with poorly controlled diabetes mellitus developed spiky continuous fever for one month. After admission, she fell suddenly into respiratoryfailure with interstitial shadowin both of the lung fields by chest x-ray examination. This was diagnosed as adult respiratorydistress syndrome following DIC. In addition, the remarkable finding of a 2560 fold increase in antinuclear antibody (ANA) levels suggested that the syndrome was linked with a connective tissue disease with interstitial pneumonia. Steroid treatment, however, failed to cure the respiratory failure. Chest x-ray examination findings gradually changed toward milliary shadow, which required MTC-PCR and culture of Mycobacterium Tuberculae. Finally, she was diagnosed with disseminated milliary tuberculosis. These results taken together with the abnormal levels of ANA suggested that autoimmunological disturbances had occurred following severe systemic infection by Mycobacterium Tuberculae in this poorly controlled diabetic patient who was an immunocompromised host.