1/13. Type 1 diabetes mellitus caused by treatment with interferon-beta.A 57-year-old man was referred to our outpatient clinic after interferon-beta (IFN-beta) treatment for 7 weeks. While IFN-beta therapy was continued in our outpatient clinic, his blood glucose level increased gradually, and he was admitted to our hospital for hyperglycemia. The patient was prescribed a 1,600-kcal diet and intensive insulin therapy was performed. GAD antibody became positive 15 months after the start of IFN therapy, and disappeared 27 months after the start of IFN therapy. Insulin secretion was depleted and the patient had HLA-DR4, B54, and DRB1*0405. This appears to be a case of type 1 diabetes mellitus induced by administration of IFN-beta alone.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
2/13. A case of chronic hepatitis c developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy.We report a case of chronic hepatitis c presenting insulin-dependent diabetes mellitus (IDDM) associated with various autoantibodies including possible anti-insulin receptor antibody (AIRA) during interferon (IFN) therapy. A 57-year-old man having chronic hepatitis c virus (HCV) infection with chronic thyroiditis received IFN therapy. The thyroid function was well-controlled by administration of thyroid hormone, although thyroid autoantibodies were positive. At 15 weeks after starting IFN (reaching 530 million units of total dose), marked thirst happened, with increased fasting plasma glucose level (488 mg/dl) and decreased daily urinary C peptide immunoreactivity level (less than 4.2 microg/day). IDDM occurred with anti-nuclear antibody (ANA), anti-dna antibody and possible AIRA, and thyroid autoantibodies titers increased, but without pancreatic islet cell antibody and anti-glutamic acid decarboxylase antibody. Administration of IFN was stopped and insulin treatment was started, but plasma glucose level was not controlled well. AIRA became negative 2 months later, however, insulin antibody (IA) was positive when tested after 18 months. serum HCV rna has been negative, and a normal level of serum transaminase has been observed since IFN therapy. It is likely that IFN therapy induced the immunological disturbance and resulted in occurrence of various autoantibodies and IDDM in the patient.- - - - - - - - - - ranking = 1.0706220898361keywords = diabetes mellitus, diabetes, mellitus, insulin-dependent (Clic here for more details about this article) |
3/13. liver transplantation eliminates insulin needs of a diabetic patient.organ transplantation and subsequent therapeutic agents may induce or worsen preexisting diabetes mellitus. We report the case of a diabetic patient whose insulin needs disappeared after liver transplantation. Non insulin-dependent diabetes mellitus was diagnosed when she was 47, and was treated by hypoglycemic drugs and then insulin. Chronic post-hepatitis c cirrhosis was diagnosed at the age of 55 and required liver transplantation 2 years later. During the postoperative course, the insulin doses required to maintain normal glucose levels progressively decreased, and insulin became completely unnecessary by the 29(th) postoperative day. After insulin was stopped, glucose levels remained within normal ranges for the 5-year-long follow-up, despite the worsening of a preexisting diabetic nephropathy and the occurrence of a diabetic retinopathy. This case highlights the fact that liver transplantation may eliminate insulin needs in a diabetic patient but also shows that degenerative complications may occur despite apparent remission of diabetes.- - - - - - - - - - ranking = 0.45492030222854keywords = diabetes mellitus, diabetes, mellitus, insulin-dependent (Clic here for more details about this article) |
4/13. Development of insulin-dependent diabetes mellitus in a patient with chronic hepatitis c during therapy with interferon-alpha.Interferon (IFN)-alpha is used for the treatment of chronic viral hepatitis. It has been associated with various forms of autoimmune disease, e.g. autoimmune hepatitis, Hashimoto thyroiditis and insulin-dependent diabetes mellitus. Further, an increase of insulin resistance and development of non-insulin-dependent diabetes mellitus has been described after treatment with IFN-alpha. Several studies have investigated the induction of different autoimmune markers by IFN-alpha, but only few specified patients who developed insulin-dependent diabetes mellitus. We report the case of a 37-year-old man with chronic hepatitis c who was treated with IFN-alpha plus ribavirin. Thirty weeks after the start of treatment, the patient developed insulin-dependent diabetes mellitus and therapy was withdrawn. HLA typing showed an HLA-DR1,3 phenotype. At manifestation of diabetes mellitus, the c-peptide level was 0.37 ng/ml (normal range 0.5-3 ng/ml). The patient had a positive family history for type 2 diabetes. Several autoimmune markers were investigated before, during and 6 months after withdrawal of antiviral treatment. High titres of glutamic acid decarboxylase (GAD) antibodies were present before therapy. A significant increase in titres of islet cell antibodies, parietal cell antibodies and sperm antibodies was present after 14 weeks of IFN-alpha treatment. Six months after withdrawal of IFN-alpha therapy, these antibodies had significantly decreased whereas GAD antibodies remained unchanged. There was no clinical sign of any other autoimmune disease. Our data show that, in patients with a predisposition to insulin-dependent diabetes mellitus, the disease may become manifest as a side-effect during therapy with IFN-alpha. Several pathogenetic factors may be involved in this process, and, in addition to IFN-alpha, hepatitis c itself may induce autoimmune mechanisms. We conclude that screening for autoantibodies specific for type 1 diabetes should be performed before the start of IFN-alpha treatment. In patients found to be at increased risk of developing diabetes mellitus type 1, monitoring of titres of these antibodies during therapy could help to assess the individual risk-benefit ratio of IFN-alpha treatment.- - - - - - - - - - ranking = 2.4087115302276keywords = diabetes mellitus, diabetes, mellitus, insulin-dependent (Clic here for more details about this article) |
5/13. Fulminant autoimmune Type 1 diabetes during interferon-alpha therapy: a case of Th1-mediated disease?AIM: A case of autoimmune Type 1 diabetes with some unique characteristics developing in a 29-year-old male during treatment with interferon-alpha (IFN-alpha) for chronic hepatitis c virus (HCV) hepatitis is reported. PATIENT AND methods: In this patient IFN-alpha treatment was well tolerated and successful in the cure of hepatitis with eradication of HCV infection within 3 months, but at 8.5 months Type 1 diabetes appeared and insulin therapy was started and maintained thereafter. HLA class II molecular typing was determined and retrospective measurement of islet cell (ICA), glutamate decarboxylase (GADA), tyrosin phosphatase IA-2 (IA-2A) and insulin (IAA) antibodies was performed in serum samples obtained before and at 0.5, 1, 2, 3, 4, 5, 6, 8.5, 10 and 13 months after the beginning of IFN-alpha treatment. RESULTS: Complete HLA class II typing was consistent with homozygosity for the HLA DRB *03011, DQA1 *0501, DQB1 *0201 haplotype. All autoantibodies were undetectable prior to IFN-alpha therapy and remained undetectable up to 6 months of treatment; at 8.5 months, at the time of diabetes onset, ICA were detectable at low titre while GADA were present at high titre. Both ICA and GADA persisted at high levels in subsequent samples. IA-2A remained undetectable in all serum samples, while IAA appeared only after treatment with exogenous insulin. DISCUSSION: This appears to be a case of autoimmune Type 1 diabetes induced by IFN-alpha treatment and developing on a predisposed genetic background with an unusually rapid development of the autoimmune process as reflected by the absence of detectable autoantibodies up to 2.5 months prior to disease onset. In this example of fulminant Type 1 diabetes a pathogenic process unbalanced towards a Th1-mediated autoimmune response is hypothesized. Diabet. Med. 18, 329-332 (2001)- - - - - - - - - - ranking = 0.36716295835194keywords = diabetes (Clic here for more details about this article) |
6/13. myasthenia gravis during low-dose IFN-alpha therapy for chronic hepatitis c.We describe the case of a 56-year-old man who had high aminotransferase levels and anti-hepatitis c virus (HCV) antibodies. He underwent liver biopsy and biochemical screening to evaluate whether he would benefit from interferon (IFN) treatment. The patient was discharged with a diagnosis of HCV-related active chronic hepatitis, skin porphyria, and type 2 diabetes. On December 5, 1995, he began therapy with recombinant IFN-alpha at a dose of 3 MIU three times a week. He stopped this therapy in February 1996 because of asthenia, diplopia, headache, and anxiety. During IFN therapy, he had normal aminotransferase levels and no detectable HCV rna, a condition that persists to the present. Between March and May 1996, the patient was admitted several times to a neurology clinic, where myasthenia gravis was diagnosed and treatment with pyridostigmine and cyclosporine was initiated. This case and others indicate that caution should be exercised in administering IFN because low doses can be correlated with myasthenia gravis in patients without malignancies.- - - - - - - - - - ranking = 0.040795884261327keywords = diabetes (Clic here for more details about this article) |
7/13. Abrupt onset of diabetes during interferon-alpha therapy in patients with chronic hepatitis c.INTRODUCTION: interferon-alpha (IFN-alpha) is now widely used in the treatment of chronic hepatitis c. Few patients have been reported as developing impaired glucose tolerance or diabetes mellitus (DM) using this therapy. The explanation for the development of DM in chronic hepatitis c treated with IFN-alpha is unclear. We report two patients who developed an abrupt onset of diabetes during IFN-alpha for chronic hepatitis c. case reports: Two male middle-aged patients were admitted to our hospital for an abrupt onset of diabetes, in diabetic ketoacidosis, with a very short duration of hyperglycaemic symptoms. Their clinical course was similar. Case 1 never demonstrated any markers of pancreatic immunogenicity. Case 2 had high levels of decarboxylase glutamic acid autoantibodies (GADAb), before the IFN-alpha treatment that persisted. We compared initial beta-cell function and metabolic control with a group of middle-aged patients from our hospital who had recently been diagnosed with Type 1 diabetes mellitus (DM1). In contrast to these, the onset of the disease was particularly severe with beta-cell function substantially impaired and displaying unstable short-term metabolic control. CONCLUSIONS: Type 1 diabetes should be considered as a potential complication if IFN is administered to patients with chronic hepatitis c. Its onset may be severe and result in short-term difficulties in metabolic control.- - - - - - - - - - ranking = 0.68557118982929keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
8/13. hepatitis c: a review of diagnosis, management, and ocular complications from treatment.BACKGROUND: Chronic hepatitis c is a serious condition that can lead to cirrhosis of the liver, and may progress to life-threatening hepatocellular carcinoma. Timely diagnosis and treatment of patients at risk for severe liver disease from the chronic hepatitis c virus is imperative to prevent life-threatening illness. Current combination therapy of interferon alpha and ribavirin is the most successful treatment. However, patients must be monitored closely, as this therapy may produce serious ocular and systemic side effects. CASE REPORT: A 53-year-old white man, who was undergoing treatment for chronic hepatitis c with peginterferon alpha-2b and ribavirin, came to the eye clinic for routine examination. Dilated funduscopy was clear O.D., but revealed flame-shaped hemorrhages and one cotton-wool spot in the superior/temporal arcade O.S. The retinopathy was attributed to peginterferon treatment and resolved completely with no recurrences over the rest of the treatment period. CONCLUSION: patients in need of treatment for chronic hepatitis c should have a baseline fundus examination before initiating treatment to identify any pre-existing retinopathy. patients with pre-existing retinopathy from diabetes or hypertension should be monitored monthly for progression throughout the course of treatment for chronic hepatitis c. patients without pre-existing retinopathy in whom mild interferon retinopathy develops should be monitored monthly until the retinopathy resolves. patients in whom proliferative retinopathy develops must be re-evaluated by their internists to determine whether treatment for chronic hepatitis c should be continued. These patients should also be referred for consultation for pan-retinal photocoagulation.- - - - - - - - - - ranking = 0.040795884261327keywords = diabetes (Clic here for more details about this article) |
9/13. melioidosis in a traveller from thailand: case report.A 42-year old Italian male with type 2 diabetes and HCV-related chronic hepatitis spent 6 months in thailand. After his return in June 2002 he was admitted to the Infectious Diseases Unit of the Hospital of Livorno (italy) because of fever, chest pain and skin abscesses in the legs. Chest x-rays and CT scan revealed multiple bilateral cavitary lesions in the lungs. ultrasonography and CT scan showed numerous subcentimetric spleen abscesses. burkholderia pseudomallei was isolated from the cutaneous lesions and sputum and thus melioidosis was diagnosed. A 6-week course of i.v. ceftazidime plus oral doxycycline was given during the acute phase of the illness. The in vitro susceptibility testing showed that long-term (20 weeks) antimicrobial therapy with doxycycline and moxifloxacin was required. Complete resolution of pulmonary and spleen lesions was obtained within 6 weeks of therapy and of cutaneous abscesses in 10 weeks. No significant side effects were noted during the follow-up period using this scheme of antimicrobial therapy.- - - - - - - - - - ranking = 0.040795884261327keywords = diabetes (Clic here for more details about this article) |
10/13. Late development of diabetes mellitus after interferon-alfa and ribavirin therapy for chronic hepatitis c: a case report.OBJECTIVE: To report the late development of immune-mediated diabetes mellitus after completion of alfa-interferon therapy for hepatitis c in an Asian patient. CLINICAL PRESENTATION AND INTERVENTION: A 50-year-old male with chronic hepatitis c received treatment with alfa-interferon and ribavirin for 52 weeks. He developed immune-mediated diabetes mellitus with low c-peptide and positive antiglutamic acid decarboxylase antibody after completion of therapy. The hepatitis c infection was eradicated, but he continued to be diabetic requiring insulin therapy during the follow-up. CONCLUSION: This report shows thatimmune-mediateddiabetes mellitus can occur as a late complication of alfa-interferon therapy.- - - - - - - - - - ranking = 1.4keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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