Fulminant Type 1 Diabetes Mellitus and Fulminant Viral Myocarditis

Abstract

SummaryA 35-year-old Japanese woman was admitted with coma following flu-like symptoms. She was diagnosed with diabetic ketoacidosis and fulminant type 1 diabetes (FT1D) and received intravenous infusion of insulin and saline. The next day, the ketoacidosis disappeared, and she recovered consciousness. However, extensive ST-segment elevations in the electrocardiogram appeared with a positive troponin test, and the patient developed pulmonary edema on day 3. An echocardiogram showed globally reduced wall motion of the left ventricle and mild pericardial effusion. Despite medical therapy with intravenous furosemide, carperitide, and catecholamines, her cardiac function deteriorated rapidly, with the left ventricular ejection fraction decreasing to 26% within 7 hours, and progressed to cardiogenic shock that afternoon. The patient received mechanical circulatory support for 4 days with intra-aortic balloon pumping and percutaneous cardiopulmonary support, and recovered fully from circulatory failure. A paired serum antibody test showed a significantly elevated titer against parainfluenza-3 virus, indicating a diagnosis of fulminant viral myocarditis. She was discharged on multiple daily insulin injection therapy, and her subsequent clinical course has been uneventful. In summary, we present a case of concurrent FT1D and fulminant viral myocarditis. Parainfluenza-3 viral infection was confirmed serologically and was considered to be a cause of both the FT1D and fulminant myocarditis. (Int Heart J 2015; 56: 239-244)

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

“…Some cases showed the elevation of pancreatic exocrine enzymes with pancreatic swelling before the onset of FT1D [10]. Regarding myocarditis associated with FT1D, it has been reported that 4 cases developed myocarditis several days after symptoms of FT1D [5]. Our patient showed pancreatitis, FT1D and myocarditis consecutively in short period.…”

“…However, the etiology of FT1D remains elusive. Several cases with concomitant acute pancreatitis [ 3 , 4 ] or myocarditis [ 5 – 8 ] during the clinical course of FT1D were previously reported. Herein, we describe a 31-year-old Japanese woman with FT1D who was initially diagnosed with acute pancreatitis and then developed diabetic ketoacidosis and myocarditis.…”

Fulminant Type 1 Diabetes Mellitus Associated with Coxsackie Virus Type A2 Infection: A Case Report and Literature Review

“…Our patient presented with fever and fatigue without any other symptoms before developing FT1D, and the Coxsackie A2 virus infection was confirmed serologically. Table 2 summarizes the reported cases in which virus infection was proven to be involved in the development of FT 1D (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). These cases include adults of both sexes.…”

Parainfluenza 3 Respiratory Infection Associated with Pericardial Effusion in a Very Low Birthweight Infant

“…There are two other cases reported in adults. In the first one, parainfluenza 3 viral infection was considered to be the cause of a fulminant myocarditis with pericardial effusion in a 35-year-old woman with diabetic ketoacidosis and type 1 diabetes [3]. The second one described a 62-year-old woman with pneumonia and pericardial effusion as a result of infection with parainfluenza virus type 4 and thrombotic thrombocytopenic purpura [4].…”