Slowly Progressive Type 1 Diabetes Mellitus Associated with Vitiligo Vulgaris, Chronic Thyroiditis, and Pernicious Anemia

Abstract

A 81-year-old woman was diagnosed as having diabetes mellitus (DM) at 58 years of age. She started insulin therapy the following year, but her blood sugar levels were poorly controlled. At the age of 75, she tested positive for the anti-GAD antibody (7.8 U/ml) and was diagnosed as having slowly progressive type 1 DM (SPIDDM), as well as vitiligo vulgaris. At 78 years of age, chronic thyroiditis was diagnosed after positive tests for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl. Low serum vitamin B12 levels and the finding of erythroblastic hyperplasia with megaloblasts in bone marrow led to the diagnosis of pernicious anemia. Anemia was alleviated by intramuscular injections of vitamin B12 . The patient developed chronic thyroiditis, vitiligo vulgaris, and pernicious anemia concomitantly with SPIDDM, and was diagnosed as having polyglandular autoimmune syndrome type III. Attention should be paid to these potentially associated autoimmune diseases in daily practice during the follow-up of SPIDDM patients.

Type 1 Diabetes Mellitus and Pernicious Anemia in an Elderly Japanese Patient: A Case Report and Literature Review

“…We herein describe a patient with pernicious anemia that occurred 8 years after his diagnosis of acute-onset T1D. In addition, all 14 previously reported cases of Japanese patients with concomitant T1D and pernicious anemia are reviewed (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Association Between Foxp3 (Rs3761548) Promoter Polymorphism With Vitiligo Patients, Their Clinical Data and Response to Phototherapy: A Study From Egypt

“…Multiple observations strongly support the role of autoimmune processes in vitiligo. First, the strong association between vitiligo and other autoimmune disorders like Addison's disease 5 , Alopecia Areata 6 , Rheumatoid arthritis 7 , Type 1 Diabetes Mellitus 8 , Systemic Lupus 9 , Pemphigus Vulgaris 10 , Graves' disease 11 , Autoimmune thyroiditis 12 and pernicious anaemia 13 . Second, it strongly runs in families with a positive history of vitiligo and other autoimmune disorders 14 .…”

An Obese Patient with Slowly Progressive Type 1 Diabetes Diagnosed by Ketoacidosis

“…Autoimmune type 1 diabetic patients can be categorized in at least two clinical subtypes: acute onset type 1 diabetes (1) and slowly progressive type 1 (insulin-dependent) diabetes (SPIDDM) (2). SPIDDM is a disease in which diabetes mellitus, after an initial non-insulin dependent stage, progresses to an insulin-dependent state as a result of a gradual decrease in insulin secretion and the presence islet cells (3). It is prevalent and found in 10% of phenotypic type 2 diabetic patients (4).…”