A case of pegylated interferon alpha-related diabetic ketoacidosis: can this complication be avoided?

Abstract

We report the case of a 42-year-old woman with chronic hepatitis C (genotype 1), who in June 2004 started therapy with pegylated interferon alpha (PEG-IFNalpha) plus ribavirin. Two months later, she discontinued treatment because of polydipsia, polyuria and vomiting leading to a marked dehydration. Biochemical data showed type 1 diabetes mellitus with ketoacidosis, and insulin therapy was started. The patient, who before starting PEG-IFN alpha plus ribavirin therapy tested negative for glutamic acid decarboxylase antibodies (GADAb) and islet cell (ICAb) antibodies, became strongly positive for both autoimmune markers. This case confirms that patients with chronic hepatitis C who do not have baseline markers of pancreatic autoimmunity may develop severe ketoacidosis during treatment with PEG-IFNalpha, as well as with standard IFNalpha. In order to avoid this complication, as no guidelines are available and the pancreatic autoimmunity markers are not routinely analysed, we suggest frequent monitoring (e.g., every one to two weeks) of glycaemic values: e.g., every one to two weeks during the first 3 months (when this complication occurs most frequently) and monthly thereafter so as to identify diabetes at an early stage and before the onset of the appearance of severe ketoacidosis, which is life-threatening.

Trajectories of anti-islet autoantibodies before development of type 1 diabetes in interferon-treated hepatitis C patients. Case reports and a literature review

“…He had no family history of diabe-body negative even after the onset of type 1 diabetes, although data for some autoantibodies such as ZnT8Ab were not available. These results suggest that GADAb may be a good predictive and diagnostic marker for IFN-induced type 1 diabetes, as has been reported in sporadic cases [2][3][4][5][6][7][8][9][10][11][12]. This needs to be verified in the future study using a large number of subjects.…”

Association of pancreatic autoantibodies and human leukocyte antigen haplotypes with resolution of diabetes mellitus after therapy for hepatitis C virus infection in patients with HIV infection: case report and review of literature

“…In the era of pegylated interferon a and ribavirin for chronic hepatitis C, 13 cases of new-onset DM during or soon after treatment have been reported in the English literature, including one HIV-infected individual [3,5,[13][14][15]. Pancreatic autoantibodies were present in six of the cases, and autoimmune destruction of b cells triggered by interferon a therapy has been proposed to be the cause of DM.…”

Loss of stress response as a consequence of viral infection: implications for disease and therapy

“…Reports observe that interferon therapy is associated with an increase in autoimmune thyroid disease, type 1 diabetes, membranous nephropathy, and other self-antigeninduced diseases (Mammen et al 2012;Radhakrishnan et al 2005;Scavone et al 2010;Tosone et al 2007;Tsai et al 2012).…”