A case of chronic hepatitis C developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy
Introduction
Interferon (IFN) therapy has been applied on not only several malignancies but also chronic hepatitis due to hepatitis C virus (HCV) because of its anti-tumor and anti-viral effects. Systemic side effects of IFN therapy can involve numerous organ systems. These adverse reactions include a flu-like syndrome, hematological abnormalities, cardiovascular and central nervous symptoms, gastrointestinal symptoms, diabetes mellitus, autoimmune disorders, pulmonary dysfunction, depression and retinopathy [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Frequency of glucose intolerance and its progress is reported to be about 0.1–0.6% [13], [14], [15]. Thus, among adverse reactions during IFN therapy, insulin-dependent diabetes mellitus (IDDM) is relatively rare and few cases with anti-pancreatic islet cell antibody (ICA) or anti-glutamic acid decarboxylase (GAD) antibody have been reported [1], [2], [3], [4], [5], [6], [7]. We report a case presenting IDDM associated with various autoantibodies including possible anti-insulin receptor antibodies (AIRA) during IFN therapy for chronic hepatitis C.
Section snippets
Case report
A 57-year-old man was admitted to our hospital to receive IFN therapy for chronic hepatitis due to HCV in November 1992. He had an episode of blood transfusion during partial gastrectomy because of a gastric ulcer in 1972. Thyroid hormone had been administered since he was diagnosed as having hypothyroidism due to chronic thyroiditis in October 1989. At that time, he was first noted as exhibiting abnormalities of blood biochemistry such as alanine aminotransferase (ALT) and
Discussion
In our patient, fasting plasma glucose and HbA1C levels before IFN therapy were normal. ICA, anti-GAD antibody and IA at onset of IDDM, and AIRA before IFN therapy were negative. The patient’s thyroid function had been well controlled by administration of thyroid hormone. The fact that sudden onset of symptom and development of hyperglycemia are therefore strongly suggested to be associated with the IFN therapy. Decrease in insulin production may have occurred because the urinary level of CPR
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