J Korean Diabetes Assoc.  2007 Sep;31(5):444-450.

A Case of Fulminant Type 1 Diabetes with Pulmonary Hypertension

Affiliations
  • 1Department of Internal Medicine, Wallace Memorial Baptist Hospital.

Abstract

Some patients with idiopathic type 1 diabetes have a fulminant disorder characterized by the absence of insulitis and of diabetes-related antibodies, a remarkably abrupt onset and high serum pancreatic enzyme concentrations. This is referred to as fulminant type 1 diabetes. Cardiopulmonary disorders are rarely observed around the onset of fulminant type 1 diabetes. A 51-year-old woman suffering from nausea and vomiting was transferred to our hospital. Laboratory findings revealed high blood glucose level and the evidence of diabetic ketoacidosis, but the serum HbA1c was normal nevertheless. The low level of plasma C-peptide indicated the loss of endogenous insulin secretion. The patient satisfied the criteria for the diagnosis of fulminant type 1 diabetes. Electrocardiogram (ECG) revealed nonspecific ST-T-wave abnormalities. Transthoracic echocardiogram demonstrated that she had severe pulmonary hypertension and minimal pericardial effusion. In a week, pulmonary hypertension improved to mild degree without specific treatment. Acute myocarditis was suspected based upon flulike symptoms, nonspecific ST-T-wave abnormalities, minimal pericardial effusion and asymptomatic pulmonary hypertension. We considered it worthwhile reporting this case because fulminant type 1 diabetes with acute myocarditis has never been published yet.

Keyword

Acute Myocarditis; Fulminant Type 1 Diabetes; Pulmonary Hypertension

MeSH Terms

Antibodies
Blood Glucose
C-Peptide
Diabetic Ketoacidosis
Diagnosis
Electrocardiography
Female
Humans
Hypertension, Pulmonary*
Insulin
Middle Aged
Myocarditis
Nausea
Pericardial Effusion
Plasma
Vomiting
Antibodies
Blood Glucose
C-Peptide
Insulin

Figure

  • Fig. 1 Electrocardiograms showing nonspecific ST-T-wave abnormalities. A, T-wave inversion in leads V1-V4 at presentation; B, ST-segment elevation in leads V2-V4 and T-wave inversion in leads II, III, aVF, V1-V6 on the following day.

  • Fig. 2 Chest X-ray. There is no evidence of parenchymal infiltrates or mass lesion in the whole lung fields. The cardiac silhouette is of normal shape and position, but the cardiac size is mildly increased in terms of C/T ratio (0.55).

  • Fig. 3 Chest CT. A, Enlarged and inhomogeneous density of both thyroid gland; B and C, No evidence of pulmonary thromboembolism was seen; D, No definitely abnormal lung parenchymal lesion was seen.


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