Fulminant type 1 diabetes mellitus associated with Coxsackievirus type B1 infection during pregnancy: a case report

Abstract

Background Fulminant type 1 diabetes is characterized by an intrinsic insulin deficiency resulting from the severe destruction of pancreatic β cells and it rapidly leads to ketoacidosis. However, the association between fulminant type 1 diabetes in pregnancy and specific viral infections has not been reported. Case presentation The patient in this study was a 31-year-old Japanese woman, and at 30 weeks of pregnancy she was admitted with marked fatigue. Fetal bradycardia was noted, and the child was delivered by emergency cesarean section but was stillborn. The maternal blood sugar level was high (427 mg/dL), but the glycated hemoglobin value was 6.2%; therefore, fulminant type 1 diabetes was suspected. Serum antibody testing confirmed a Coxsackievirus B1 infection. The patient in this case had fulminant type 1 diabetes in pregnancy associated with Coxsackievirus B1. Conclusion This case highlights that fulminant type 1 diabetes in pregnancy may be associated with Coxsackievirus B1 infection.

Cryo-EM structures reveal the molecular basis of receptor-initiated coxsackievirus uncoating

“…Group B coxsackieviruses (CVBs) are members of the Picornaviridae family and cause various potentially life-threatening inflammatory diseases in both infants and adults worldwide, with infants being particularly susceptible to generalized CVB infections (Lugo and Krogstad, 2016;Tavakoli et al, 2008). In recent years, severe outbreaks of CVB infections have been documented in Asia, Europe, and North America (Abedi et al, 2018;Centers for Disease Control and Prevention, 2010;Delogu et al, 2018;Hayakawa et al, 2019;Pauwels et al, 2012). In particular, in the United States, CVB accounts for 4 out of the top-15 most-frequently occurring enterovirus serotypes from 2014-2016 (Abedi et al, 2018).…”

Fulminant type 1 diabetes mellitus in a GDM pregnancy: early recognition is vital for maternal and fetal outcomes

“…The incidence of fulminant type 1 diabetes in Caucasians is relatively low ( 2 ). To the best of our knowledge, the occurrence of FT1DM in pregnancy has only been reported in patients of East Asian or Southeast Asian ethnicity ( 1 , 2 , 3 , 4 , 5 ), and our case represents the only case of FT1DM occurring in a pregnancy with GDM reported in the English literature thus far. The extremely rapid beta-cell destruction and abrupt development of hyperglycaemia associated with FT1DM are in stark contrast to autoimmune type 1 diabetes, which progresses slowly and takes at least several years from the initial appearance of autoantibodies in the peripheral blood to the clinical onset of disease ( Figs 1 and 2 ).…”

“…FT1DM was first described in Japan in 1987 and has since been reported in other parts of the world, predominantly in East Asia and Southeast Asia ( 1 , 2 , 3 , 4 , 5 ). The incidence of fulminant type 1 diabetes in Caucasians is relatively low ( 2 ).…”

“…The pathophysiology of FT1DM is incompletely understood but both environmental and genetic susceptibility have been suggested. The role of autoimmunity remains uncertain ( 1 , 3 , 4 ). A characteristic of FT1DM is its predilection for pregnancy with the onset of diabetes typically in the third trimester, as seen in our patient, or immediately after delivery.…”

Innate Viral Sensor MDA5 and Coxsackievirus Interplay in Type 1 Diabetes Development

“…There are two groups of coxsackievirus, A and B, which both cause hand, foot, and mouth disease (HFMD) [29,30]. The coxsackievirus type A (CVA) group has 24 serotypes; this group causes flaccid paralysis and severe infection [31,32]. The coxsackievirus type B (CVB) group has six serotypes, all correlated with T1D, known for causing spastic paralysis with mild infections [33][34][35][36][37][38][39][40][41][42][43][44][45].…”