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[Myocarditis and insulitis following coxsackie virus infection]
Insights
A viral infection, specifically coxsackie-B virus type 4, was identified as a potential cause of acute diabetes in a young girl. This finding suggests viruses may play a role in juvenile diabetes development.
Area of Science:
- Virology
- Endocrinology
- Pathology
Background:
- Acute insulin-dependent diabetes mellitus (juvenile diabetes) can have various etiologies.
- Viral infections are increasingly recognized as potential triggers for autoimmune and metabolic disorders.
Observation:
- A pediatric patient developed severe diabetes post-atrial septum defect surgery.
- Autopsy revealed myocarditis with viral characteristics and pancreatic islet necrosis with lymphocytic infiltrates.
- Coxsackie-B virus type 4 (CBV-4) antibodies and antigens were detected in the patient's islet tissue.
Findings:
- The presence of CBV-4 antibodies and intracellular viral antigens in pancreatic islets strongly suggests a viral etiology for the observed diabetes.
- The myocarditis further supports a systemic viral infection.
Implications:
- This case highlights the potential role of viral infections, particularly coxsackie-B viruses, in the pathogenesis of juvenile diabetes.
- Further research into viral triggers for diabetes is warranted to improve prevention and treatment strategies.
Abstract:
We report on the case of a 5 7/12-year-old girl, who presented an acute insulin-dependent diabetes mellitus nineteen days after the operative suture of an atrial septum defect, and who died in a hyperosmolar coma diabeticum in spite of an intensive therapy. At the autopsy there was shown a myocarditis with the histological characteristics of a virus infection. The islet tissue of the pancreas was largely necrotic, the great majority of the islets of Langerhans presented lymphocytic infiltrates. In a neutralisation test against coxsackie-B-viruses (CBV), which was conducted after death, there was found among others an antibody titer of 1:192 against CBV-4. With FITC-marked CBV-antiglobulin, in the islet tissue intracellular CBV-antigen could be proved. It is discussed that virus infections have an etiological importance for the incidence of a so-called juvenile diabetes in man.