부산대학교 도서관

A 52-year-old man who had undergone steroid therapy at 27 years of age presented to our emergency unit complaining of poor appetite, abdominal pain, and disturbance of consciousness in mid-January 2015. An examination at presentation revealed diabetic ketoacidosis with pH of 7.021, urine ketone body of 2+, blood glucose of 1111 mg/dL, and HbA1c of 6.3 %. Continuous intravenous insulin infusion with adequate fluid therapy was started. Based on the findings of an increase in the levels of pancreatic exocrine enzymes with a subsequently confirmed absence of islet-specific autoantibodies and depletion of endogenous insulin secretion as evidenced by fasting blood CPR of 0.1 ng/dL, 2-h postprandial blood CPR of 0.1 ng/dL, and urinary CPR of 8.2 μg/day, fulminant type 1 diabetes mellitus was diagnosed. The patient had an HLA haplotype of DRB1*04:05-DQB1*04:01, which is a common susceptibility factor for Harada disease and fulminant type 1 diabetes mellitus. There was also a change in the antibody titer against enterovirus (type B1 Coxsackie virus) after admission. He was suspected of having developed fulminant type 1 diabetes mellitus triggered by a new infection with enterovirus 25 years after the development of Harada disease.