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Current Diabetes Reviews

Author(s): Martinot Amelie, Demar Magalie, Thelusme Liliane, Bounoua Merzaka, Santa Florin, Dueymes Maryvonne, Vujica Jelena, Dequidt Henry and Sabbah Nadia*

DOI: 10.2174/1573399815666191025141841

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Uncommon Association Between Diabetic Ketoacidosis, Thyrotoxicosis, Cutaneous Abscess and Acute Pericarditis in an Immunocompetent Patient: A Single Case Report and Literature Review

Page: [641 - 648] Pages: 8

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Abstract

Introduction: The typical factors precipitating diabetic ketoacidosis (DKA) include infections (30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis, pericarditis and diabetes mellitus.

Case Report: A fifty-year-old Surinamese woman without any medical history was admitted for diabetic ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous abscess. The patient was infected with HTLV-1.

Conclusion: To our knowledge, this uncommon association is described for the first time. Few studies have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.

Keywords: Diabetes mellitus, diabetic ketoacidosis, thyroiditis, acute pericarditis, infection, human T lymphotropic virus type 1.

[1]
Lebovitz HE. Diabetic ketoacidosis. Lancet 1995; 345(8952): 767-72.
[http://dx.doi.org/10.1016/S0140-6736(95)90645-2] [PMID: 7891491]
[2]
Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab 2012; 16(Suppl. 1): S27-36.
[http://dx.doi.org/10.4103/2230-8210.94253] [PMID: 22701840]
[3]
Sano H, Terasaki J, Tsutsumi C, Imagawa A, Hanafusa T. A case of fulminant type 1 diabetes mellitus after influenza B infection. Diabetes Res Clin Pract 2008; 79(3): e8-9.
[http://dx.doi.org/10.1016/j.diabres.2007.10.030] [PMID: 18177974]
[4]
Hosokawa Y, Hanafusa T, Imagawa A. Pathogenesis of fulminant type 1 diabetes: Genes, viruses and the immune mechanism, and usefulness of patient-derived induced pluripotent stem cells for future research. J Diabetes Investig 2019; 10(5): 1158-64.
[http://dx.doi.org/10.1111/jdi.13091] [PMID: 31161717]
[5]
Zhu B, Wu J, Chen G, Yang Y, Yi C. Fulminant type 1 diabetes mellitus caused by drug reaction with eosinophilia and systemic symptoms (dress): a case report and review of the literature. Front Endocrinol (Lausanne) 2019; 10: 474.
[http://dx.doi.org/10.3389/fendo.2019.00474] [PMID: 31379742]
[6]
Imagawa A, Hanafusa T. Pathogenesis of fulminant type 1 diabetes. Rev Diabet Stud 2006; 3(4): 169-77.
[http://dx.doi.org/10.1900/RDS.2006.3.169] [PMID: 17487341]
[7]
Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) In: Feingold KR, Anawalt B, Boyce A, etal, eds Endotext South Dartmouth (MA): MDTextcom, Inc 2000.http://www.ncbi.nlm.nih.gov/books/NBK279052/
[8]
Goldenberg RM, Berard LD, Cheng AYY, et al. SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clin Ther 2016; 38(12): 2654-2664.e1.
[http://dx.doi.org/10.1016/j.clinthera.2016.11.002] [PMID: 28003053]
[9]
Lee S, Morgan A, Shah S, Ebeling PR. Rapid-onset diabetic ketoacidosis secondary to nivolumab therapy. Endocrinol Diabetes Metab Case Rep 2018; 201818-0021.
[http://dx.doi.org/10.1530/EDM-18-0021] [PMID: 29732161]
[10]
Tzoulis P, Corbett RW, Ponnampalam S, et al. Nivolumab-induced fulminant diabetic ketoacidosis followed by thyroiditis. Endocrinol Diabetes Metab Case Rep 2018; 2018: 18-0111.
[http://dx.doi.org/10.1530/EDM-18-0111] [PMID: 29576870]
[11]
Sakurai K, Niitsuma S, Sato R, Takahashi K, Arihara Z. Painless thyroiditis and fulminant type 1 diabetes mellitus in a patient treated with an immune checkpoint inhibitor, nivolumab. Tohoku J Exp Med 2018; 244(1): 33-40.
[http://dx.doi.org/10.1620/tjem.244.33] [PMID: 29343652]
[12]
Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med 2006; 144(5): 350-7.
[http://dx.doi.org/10.7326/0003-4819-144-5-200603070-00011] [PMID: 16520476]
[13]
Balasubramanyam A, Garza G, Rodriguez L, et al. Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care 2006; 29(12): 2575-9.
[http://dx.doi.org/10.2337/dc06-0749] [PMID: 17130187]
[14]
Hage M, Zantout MS, Azar ST. Thyroid disorders and diabetes mellitus. J Thyroid Res 2011; 2011439463
[http://dx.doi.org/10.4061/2011/439463] [PMID: 21785689]
[15]
Solá E, Morillas C, Garzón S, Gómez-Balaguer M, Hernández-Mijares A. Association between diabetic ketoacidosis and thyrotoxicosis. Acta Diabetol 2002; 39(4): 235-7.
[http://dx.doi.org/10.1007/s005920200040] [PMID: 12486499]
[16]
Monteiro AM, Matta-Coelho C, Fernandes V, Marques O. Type 2 diabetes decompensation as the clinical presentation of thyroid storm - cause or consequence? Eur Endocrinol 2017; 13(2): 99-101.
[http://dx.doi.org/10.17925/EE.2017.13.02.99] [PMID: 29632616]
[17]
Mengíbar JL, Capel I, Bonfill T, et al. Simultaneous onset of type 1 diabetes mellitus and silent thyroiditis under durvalumab treatment. Endocrinol Diabetes Metab Case Rep 2019; 2019(1)
[http://dx.doi.org/10.1530/EDM-19-0045] [PMID: 31310083]
[18]
Hakami OA, Ioana J, Ahmad S, Tun TK, Sreenan S, McDermott JH. A case of pembrolizumab-induced severe DKA and hypothyroidism in a patient with metastatic melanoma. Endocrinol Diabetes Metab Case Rep 2019. 2019EDM180153
[http://dx.doi.org/10.1530/EDM-18-0153 ] [PMID: 30836329]
[19]
Kukla P, Bryniarski L, Bromblik A, Szczuka K, Kawecka-Jaszcz K. Myopericarditis complicated with cardiogenic shock mimicking acute coronary syndrome with ST elevation in a patient with hyperthyroidism and diabetes mellitus. Kardiol Pol 2008; 66(9): 982-6.
[PMID: 18924029]
[20]
Oki K, Matsuura W, Saito Y, et al. Infective endocarditis and acute purulent pericarditis in a patient with hyperglycemia. Intern Med 2005; 44(6): 666-70.
[http://dx.doi.org/10.2169/internalmedicine.44.666] [PMID: 16020903]
[21]
Lee H-H, Chu C-Y, Su H-M, et al. Purulent pericarditis, multi-site abscesses and ketoacidosis in a patient with newly diagnosed diabetes: a rare case report. Diabet Med 2014; 31(7): e25-8.
[http://dx.doi.org/10.1111/dme.12458] [PMID: 24698085]
[22]
Campbell IW, Duncan LJ, CLarke BF. Pericarditis in diabetic ketoacidosis. Br Heart J 1977; 39(1): 110-2.
[http://dx.doi.org/10.1136/hrt.39.1.110] [PMID: 401643]
[23]
Kashif M, Raiyani H, Niazi M, Gayathri K, Vakde T. Purulent pericarditis: an uncommon presentation of a common organism. Am J Case Rep 2017; 18: 355-60.
[http://dx.doi.org/10.12659/AJCR.902751] [PMID: 28381819]
[24]
Odubanjo AA, Kalisetti R, Adrah R, Ajenifuja A, Joseph B, Zaman M. Severe Myopericarditis in diabetic ketoacidosis-all troponin are not myocardial infarction. Clin Med Insights Case Rep 2018; 111179547618763356
[http://dx.doi.org/10.1177/1179547618763356] [PMID: 29568222]
[25]
Ishak R, Vallinoto ACR, Azevedo VN, Ishak M de OG. Epidemiological aspects of retrovirus (HTLV) infection among Indian populations in the Amazon Region of Brazil. Cad Saude Publica 2003; 19(4): 901-14.
[http://dx.doi.org/10.1590/S0102-311X2003000400013] [PMID: 12973556]
[26]
Manel N, Kim FJ, Kinet S, Taylor N, Sitbon M, Battini J-L. The ubiquitous glucose transporter GLUT-1 is a receptor for HTLV. Cell 2003; 115(4): 449-59.
[http://dx.doi.org/10.1016/S0092-8674(03)00881-X] [PMID: 14622599]
[27]
Smikle MF, Wright-Pascoe R, Barton EN, et al. Autoantibodies, human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans. West Indian Med J 2002; 51(3): 153-6.
[PMID: 12501540]
[28]
Lagaye S, Vexiau P, Morozov V, et al. Detection of HTLV-1 gag related sequences in leucocyte DNA from patients with polyendocrinopathies (Basedow-Graves’ disease and insulin-dependent diabetes). C R Acad Sci III 1991; 312(7): 309-15.
[PMID: 1908739]
[29]
Alves C, Dourado L. Endocrine and metabolic disorders in HTLV-1 infected patients. Braz J Infect Dis 2010; 14(6): 613-20.
[http://dx.doi.org/10.1016/S1413-8670(10)70120-3] [PMID: 21340303]
[30]
Neufeld M, Maclaren NK, Blizzard RM. Two types of autoimmune Addison’s disease associated with different polyglandular autoimmune (PGA) syndromes. Medicine (Baltimore) 1981; 60(5): 355-62.
[http://dx.doi.org/10.1097/00005792-198109000-00003] [PMID: 7024719]
[31]
Sobngwi E, Mauvais-Jarvis F, Vexiau P, Mbanya JC, Gautier JF. Diabetes in Africans. Part 2: Ketosis-prone atypical diabetes mellitus.Diabetes Metab 2002; 28(1): 5-12.
[PMID: 11938022]
[32]
Ketosis prone diabetes presenting as fulminant type 1 diabetes. Pan Afr Med J 2018; 31
[http://dx.doi.org/10.11604/pamj.2018.31.38.16162]
[33]
Lee YJ, Kim DW. Sonographic characteristics and interval changes of subacute thyroiditis. J Ultrasound Med 2016; 35(8): 1653-9.
[http://dx.doi.org/10.7863/ultra.15.09049] [PMID: 27302899]
[34]
Paunkovic J, Paunkovic N. Does autoantibody-negative Graves’ disease exist? A second evaluation of the clinical diagnosis. Horm Metab Res 2006; 38(1): 53-6.
[http://dx.doi.org/10.1055/s-2006-924979] [PMID: 16477542]
[35]
Osada E, Hiroi N, Sue M, et al. Thyroid storm associated with Graves’ disease covered by diabetic ketoacidosis: A case report. Thyroid Res 2011; 4(1): 8.
[http://dx.doi.org/10.1186/1756-6614-4-8] [PMID: 21492449]
[36]
Poudel RR, Belbase B, Belbase B, Kafle NK. Apathetic thyrotoxicosis presenting with diabetes mellitus. J Community Hosp Intern Med Perspect 2014; 4(5): 25502.
[http://dx.doi.org/10.3402/jchimp.v4.25502] [PMID: 25432651]
[37]
Wang J, Gao X, Li Y, Ping F. A case report of fulminant type 1 diabetes mellitus caused by Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) complicated by iodine-induced thyrotoxicosis. Diabetes Ther 2019; 10(3): 1145-50.
[http://dx.doi.org/10.1007/s13300-019-0607-5] [PMID: 30937841]
[38]
Popovic D, Lalic K, Jotic A, et al. The inflammatory and hemostatic cardiovascular risk markers during acute hyperglycemic crisis in type 1 and type 2 diabetes. J Med Biochem 2019; 38(2): 126-33.
[http://dx.doi.org/10.2478/jomb-2018-0024] [PMID: 30867640]
[39]
Lee H-H, Chu C-Y, Su H-M, et al. Purulent pericarditis, multi-site abscesses and ketoacidosis in a patient with newly diagnosed diabetes: a rare case report. Diabet Med 2014; 31(7): e25-8.
[http://dx.doi.org/10.1111/dme.12458] [PMID: 24698085]
[40]
Mahesh MG, Shivaswamy RP, Chandra BS, Syed S. The study of different clinical pattern of diabetic ketoacidosis and common precipitating events and independent mortality factors. J Clin Diagn Res 2017; 11(4): OC42-6.
[http://dx.doi.org/10.7860/JCDR/2017/25347.9760] [PMID: 28571190]
[41]
Gupta P, Chhabra L, Hiendlmayr B, Spodick DH. Thyrotoxic pericarditis: An underappreciated phenomenon. Int J Cardiol 2015; 198: 32-3.
[http://dx.doi.org/10.1016/j.ijcard.2015.06.130] [PMID: 26149336]
[42]
Inami T, Seino Y, Goda H, et al. Acute pericarditis: unique comorbidity of thyrotoxic crisis with Graves’ disease. Int J Cardiol 2014; 171(3): e129-30.
[http://dx.doi.org/10.1016/j.ijcard.2013.12.042] [PMID: 24411211]
[43]
Clarke NRA, Banning AP, Gwilt DJ, Scott AR. Pericardial disease associated with Grave’s thyrotoxicosis. QJM 2002; 95(3): 188-9.
[http://dx.doi.org/10.1093/qjmed/95.3.188] [PMID: 11865177]
[44]
Tsai M-S, Yang C-W, Chi C-L, Hsieh C-C, Chen W-J, Huang C-H. Acute pericarditis: a rare complication of Graves’ thyrotoxicosis? Am J Emerg Med 2006; 24(3): 374-5.
[http://dx.doi.org/10.1016/j.ajem.2005.10.020] [PMID: 16635723]
[45]
Chhabra L, Spodick DH. A comment on thyrotoxic pericarditis. Int J Cardiol 2014; 173(3): 587.
[http://dx.doi.org/10.1016/j.ijcard.2014.03.104] [PMID: 24703798]
[46]
Cullen D, Munjal N, Chalal H, Ramgopal S, Tas E, Witchel S. Pericarditis as the presenting feature of graves disease in a pediatric patient. Pediatr Emerg Care 2017; 33(4): 268-70.
[http://dx.doi.org/10.1097/PEC.0000000000000439] [PMID: 26181502]
[47]
Akamine H, Takasu N, Komiya I, et al. Association of HTLV-I with autoimmune thyroiditis in patients with adult T-cell leukaemia (ATL) and in HTLV-I carriers. Clin Endocrinol (Oxf) 1996; 45(4): 461-6.
[http://dx.doi.org/10.1046/j.1365-2265.1996.741562.x] [PMID: 8959086]
[48]
Mizokami T, Okamura K, Ikenoue H, et al. A high prevalence of human T-lymphotropic virus type I carriers in patients with antithyroid antibodies. Thyroid 1994; 4(4): 415-9.
[http://dx.doi.org/10.1089/thy.1994.4.415] [PMID: 7711504]
[49]
Mine H, Kawai H, Yokoi K, Akaike M, Saito S. High frequencies of human T-lymphotropic virus type I (HTLV-I) infection and presence of HTLV-II proviral DNA in blood donors with anti-thyroid antibodies. J Mol Med (Berl) 1996; 74(8): 471-7.
[http://dx.doi.org/10.1007/BF00217523] [PMID: 8872861]
[50]
Matsuda T, Tomita M, Uchihara J-N, et al. Human T cell leukemia virus type I-infected patients with Hashimoto’s thyroiditis and Graves’ disease. J Clin Endocrinol Metab 2005; 90(10): 5704-10.
[http://dx.doi.org/10.1210/jc.2005-0679] [PMID: 16076945]
[51]
Gessain A, Cassar O. epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol 2012; 3: 388.
[http://dx.doi.org/10.3389/fmicb.2012.00388] [PMID: 23162541]