A Case of Type 1 Diabetes Onset and Recurrence of Graves' Disease During Pegylated Interferon-Alpha Plus Ribavirin Treatment for Chronic Hepatitis C

Abstract

We report a case of type 1 diabetes onset and recurrence of Graves' disease during pegylated interferon (PEG-IFN)-alpha plus ribavirin treatment for chronic hepatitis C. The patient was a 55-year-old woman diagnosed with chronic hepatitis at age 46 years. She was treated for Graves' disease at 50 years of age. Because Graves' disease remitted, PEG-IFN-alpha plus ribavirin treatment was started for chronic hepatitis C. She was examined because of complaints of general fatigue, weight loss, and palpitations after 24 weeks of the treatment. She was diagnosed with a recurrence of Graves' disease, and methimazole treatment was started. However, she complained of malaise, thirst, polyuria, and loss of body weight. Her fasting blood glucose level was 292 mg/dL and HbA1c was 9.3%. Serum anti-GAD (glutamic acid decarboxylase) antibodies were 2.2 U/mL. She was diagnosed with type 1 diabetes with ketosis, and insulin treatment was started. Serum anti-GAD antibodies gradually increased to 15.1 U/mL. Graves' disease and type 1 diabetes are often complicated, and the coincidental occurrence of these 2 diseases is known as autoimmune polyglandular syndrome type III. However, only a few cases have shown that these diseases occur after IFN treatment.

Type 1 Diabetes Mellitus Associated with Pegylated Interferon-α Plus Ribavirin Treatment for Chronic Hepatitis C: Case Report and Literature Review

“…We reviewed the data for each of these cases, focusing on the length of time from the start of IFN+RBV therapy to the onset of type 1 diabetes mellitus, continuation/ discontinuation of IFN therapy after the onset of type 1 diabetes, weaning/nonweaning from insulin therapy after discontinuation of IFN+RBV, presence/absence of pancreas-associated autoantibodies before and after IFN+RBV therapy, and the HLA haplotype of the patients (Table 1). While in most cases IFN+RBV therapy had been discontinued immediately after the diagnosis of type 1 diabetes,3,8–16,18,20–24 the treatment had been continued in two cases, including the present case 25. Insulin therapy could be discontinued later in only two of the 19 cases in which IFN+RBV therapy had been stopped immediately after the diagnosis of type 1 diabetes 8,23.…”

“…Twenty-eight cases of type 1 diabetes mellitus diagnosed after the start of IFN+RBV therapy have thus far been reported in the English language literature 3,8–25. We reviewed the data for each of these cases, focusing on the length of time from the start of IFN+RBV therapy to the onset of type 1 diabetes mellitus, continuation/ discontinuation of IFN therapy after the onset of type 1 diabetes, weaning/nonweaning from insulin therapy after discontinuation of IFN+RBV, presence/absence of pancreas-associated autoantibodies before and after IFN+RBV therapy, and the HLA haplotype of the patients (Table 1).…”

Defining the Transcriptional and Cellular Landscape of Type 1 Diabetes in the NOD Mouse

“…Diabetes prone BB rats and mice treated with streptozotocin had expression of type I interferon in their pancreatic islets [40]. There are reports of patients treated with type I interferon for chronic viral infections that then developed diabetes [41]. In the case of mice, enforced expression of type I interferon in islets caused autoimmune diabetes [42], [43].…”

Relapse of Vogt-Koyanagi-Harada Disease during Interferon-α and Ribavirin Therapy in a Case of Chronic Viral Hepatitis C

“…Moreover, IFN-α can cause an immune response shift to T-helper-1-type predominance and alter the expression of histocompatibility class I and II antigens, possibly leading to the development of VKH disease [5, 8]. In addition, administration of IFN-α may lead to the development of VKH disease via an increase in the production of endogenous IFN-α, and it has been reported that serum endogenous IFN-α titers are significantly elevated in VKH disease patients [9, 10].…”