Simultaneous development of diabetic ketoacidosis and Hashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C

Abstract

Classical interferon-alpha has been shown to be correlated with the development of a variety of autoimmune disorders. A 38 year-old female patient developed simultaneously diabetic ketoacidosis and hyperthyroidism 5 mo following initiation of treatment with pegylated interferon-α and ribavirin for chronic hepatitis C. High titers of glutamic acid decarboxylase, antinuclear and thyroid (thyroid peroxidase and thyroglobulin) antibodies were detected. Antiviral treatment was withdrawn and the patient was treated with insulin for insulin-dependent diabetes mellitus and propranolol for hyperthyroidism. Twelve months after cessation of pegylated interferon-α therapy the patient was euthyroid without any medication but remained insulin-dependent.

Abrupt onset of type 1 diabetes mellitus during recombinant interferon-alpha 2b therapy in a patient with chronic hepatitis B

“…In 1992, Fabris et al [10] reported the first case of type 1 DM in a chronic hepatitis C patient treated with IFN-α and concluded that IFN could trigger autoimmune destruction of pancreatic beta cells. IFN-α therapy-induced autoimmunity of pancreatic beta cells has been evaluated in some studies [11][12][13][14] . The prevalence of ICAb, GADAb, insulin autoantibody (IAA), and/or tyrosine-like phosphatase autoantibody …”

“…A variety of mechanisms may account for the effect of IFN-α on pancreatic beta cell dysfunction [14] . First, IFN-α activates the oligoadenylate synthase-RnaseL pathway and the protein kinase R pathway, thus inducing apoptosis of pancreatic beta cells.…”

Diabetic Ketoacidosis

“…Until 2005, 35 cases of IFN-α related T1DM had been reported in the medical literature [64,[66][67][68][69]. DKA was reported in a few classical IFN-α related cases [70][71][72][73], in three pegylated IFN-α related cases [65,74,75]. The development of DKA and the permanent insulin dependency may be related with a rapidly developing T helper-1-mediated pathogenic mechanism [72].…”

“…Soultati et al reported a 38 year-old female patient developed simultaneously DKA and hyperthyroidism 5 months following initiation of treatment with pegylated IFN-α and ribavirin for CHC. High titers of glutamic acid decarboxylase, antinuclear and thyroid (thyroid peroxidase and thyroglobulin) antibodies were detected [65]. Until 2005, 35 cases of IFN-α related T1DM had been reported in the medical literature [64,[66][67][68][69].…”

Diagnosis, management and treatment of hepatitis delta virus infection: Turkey 2017 Clinical Practice Guidelines

“…For patients with diabetes mellitus, interferon treatment is recommended in the treatment of CDH (53,54). The treatment approaches of CDH in patients with chronic renal failure should be approached as that of chronic HBV infection (55)(56)(57).…”