A rare case of fulminant type 1 diabetes mellitus accompanied by both acute pancreatitis and myocarditis - case report

Abstract

Background: Fulminant type 1 diabetes mellitus (FT1D) is a newly established subtype of type 1 diabetes. Its etiology has not been fully elucidated. Several cases with FT1D have exhibited pancreatitis or myocarditis. Case presentation: We report a 31-year-old Japanese woman who showed upper abdominal pain and was admitted to a local hospital. She was initially diagnosed with acute pancreatitis based on serum amylase elevation and swelling of the pancreas on computed tomography. Four days after admission, she developed diabetic ketoacidosis and was transferred to our hospital. Her symptoms and laboratory findings met the FT1D criteria. On the 3rd hospital day, electrocardiography (ECG) showed ST-segment elevation, and serum cardiac enzymes were markedly elevated. Because she exhibited late gadolinium enhancement in the apical wall on contrast-enhanced cardiac magnetic resonance imaging, she was diagnosed as acute myocarditis. Abnormal ECG findings and elevations of biomarkers associated with myocarditis showed improvement on the next day. Conclusions: This is the first case of FT1D accompanied by both pancreatitis and myocarditis and suggests that the pathophysiology of FT1D is related to the common etiology of acute pancreatitis and myocarditis.

Acute Pancreatitis Simulating Myocardial Infarction: A Challenging Case

“…Although rare, cardiovascular complications can also occur in patients with acute pancreatitis, which include hypovolemia, pericardial effusion, shock or worsening of underlying ischemic heart disease, or heart failure [4]. Rarely acute pancreatitis can also be associated with many EKG changes, including arrhythmias and changes in T wave and ST-segment elevation mimicking myocardial infarction, which is not widely reported in the literature [5][6][7][8][9][10]. We have tabulated acute pancreatitis-induced cardiovascular complications in The pathophysiology of acute pancreatitis-induced MI is complex and not fully understood.…”

“…Differentiating between real and pseudo-MI is mandatory as the management strategies vary greatly for both conditions. Using thrombolytics for pseudo-MI misdiagnosed as real may lead to severe bleeding, particularly when there is underlying acute pancreatitis [4][5][6]. In patients with acute pancreatitis, symptoms like MI, troponin, brain natriuretic peptide levels, and electrolyte imbalances must be addressed, especially hyperkalemia which causes ST-segment changes [13].…”

“…When there is a high risk of acute coronary syndrome, coronary angiography can also be advised after evaluating the risk, benefits, and need for antithrombotic use [11][12][13][14]. In certain cases, conservative management with lipid-lowering drugs and antithrombotics may be advised, as acute pancreatitis is an absolute contraindication to coronary intervention [6]. In general, it is essential to keep in mind that diagnosis of pseudo-MI in acute pancreatitis or EKG changes associated with pancreatitis is the diagnosis of exclusion, and coronary artery disease must be ruled out even in the presence of chest pain or heaviness.…”

Acute Pancreatitis and Myocardial Infarction: A Narrative Review

“…Seventeen (50% or 17/34) patients had a coronary angiography performed while inpatient. One case showed evidence of acute myocarditis on cardiac MRI in a patient with fulminant diabetes type 1 and acute pancreatitis [72]. There were four (11.7% or 4/34) cases where thrombolytics were administered.…”

Diagnostic accuracy of computed tomography scoring index in predicting mortality among suspected patients of acute pancreatitis

“…CTSI is the finest example of a grading system that predicts outcomes in AP. It was introduced considering the combined imaging assessment of the pancreas and its surrounding soft tissue planes for fluid collections and to evaluate the severity of necrosis of pancreatic parenchyma for obtaining prognostic accuracy 13 . It is comparatively superior to other grading criteria, identifying not only outcomes in AP but also stage disease severity by determining loco-regional complications 14,15 .…”