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Published on: May 6, 2013
Fulminant type 1 diabetes mellitus.
Ryota Inokuchi1, Akinori Matsumoto, Hajime Odajima
1Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan. inokuchir-icu@h.u-tokyo.ac.jp
BMJ Case Reports
|August 3, 2012
Summary
A rare, rapid-onset case of fulminant type 1 diabetes mellitus was misdiagnosed as a respiratory infection. Despite normal HbA1c, autopsy revealed severe pancreatic islet cell damage, highlighting a critical diagnostic challenge.
Area of Science:
- Endocrinology
- Pathology
- Diabetology
Background:
- Fulminant type 1 diabetes mellitus (FT1DM) is a rare, aggressive form of diabetes.
- It presents with acute hyperglycemia and ketoacidosis, often mimicking other conditions.
- Early diagnosis is crucial but challenging due to atypical presentations.
Observation:
- A patient initially diagnosed with upper respiratory tract infection due to pharyngeal redness presented with cardiopulmonary arrest.
- Emergency transfer revealed extreme hyperglycemia (86.9 mmol/l), glucosuria, and ketonuria.
- Remarkably, glycosylated hemoglobin (HbA1c) was within the normal range (6.2%).
Findings:
- Autopsy confirmed marked depletion and atrophy of pancreatic islets of Langerhans, the hallmark of autoimmune destruction in type 1 diabetes.
- The normal HbA1c indicated a very recent and rapid onset of beta-cell destruction, inconsistent with chronic hyperglycemia.
- These findings confirm a fatal case of fulminant type 1 diabetes mellitus.
Implications:
- This case underscores the diagnostic difficulty of FT1DM, particularly when initial symptoms are non-specific.
- It highlights the importance of considering FT1DM in patients with acute metabolic decompensation, even with seemingly normal HbA1c levels.
- Clinicians must maintain a high index of suspicion for rapid-onset diabetes to prevent delayed diagnosis and potentially fatal outcomes.
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