Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 can result in severe disease and become critically challenging to hospitals via high demand for intensive care and mechanical ventilation. Guillain-Barré syndrome (GBS) and its variants have been described as neurologic complications of COVID-19, and fatal cases were reported. 1 The mechanisms by which COVID-19 predisposes to autoimmunity are unclear, and potential biomarkers or risk factors remain unknown. Case report A 35-year-old, healthy Caucasian woman initially presented with fever and coughing over 1 week (days 0-7, figure, A for timeline) at her family doctor and was subsequently tested positive for SARS-CoV-2 via PCR. The patient had experienced no other infections in previous weeks and had not received any vaccinations. On day 8, she developed severe diabetic ketoacidosis (DKA) as the first manifestation of type 1 diabetes (T1D; pH: 6.7; base excess: −27 mmol/L; blood glucose: 25.1 mmol/L, HbA1c: 6.4%), and antibodies against islet cell antigen 2 and glutamate decarboxylase (GAD65) were positive. There was no history of polyuria or polydipsia. She was admitted to intensive care unit and transiently recovered after fluid resuscitation and insulin treatment. However, because of rapidly developing respiratory insufficiency, intubation became necessary on day 10. Chest x-ray and CT scan showed signs suggestive of COVID-19.
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