A CASE OF LATE-ONSET TYPE 1 DIABETES MELLITUS WITH PULMONARY SUPPURATION

• Published in: Japanese Journal of National Medical Services Vol. 55; no. 11; pp. 565 - 569
• Main Authors: MORIWAKI, Kaname, NOGAMI, Toshiji, YASUDA, Shouhei, IKEDA, Hirokazu, TADOKORO, Seiji, FUJII, Hiroshi, SAYAMA, Kouichi, IIDA, Sayomi, AKIYAMA, Hiroyuki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 20.11.2001
• Subjects: glutamate decarboxylase antibodies; HLA A-24; islet-cell antibodies; pulmonary suppuration; type 1 diabetes mellitus
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.55.565

A 63-year-old man has had diabetes mellitus since the age of 55, and taken oral hypoglycemic agent during 5 years, Although he began to have insulin therapy in 1996, his glycemic control was remained to be poor. He suffered fever with cough in July 1999, His chest showed abnormal shadow of right lower lung field. On July 21, he was reffered and admitted to our hospital. A diagnosis of pulmonary suppuration was made at elevation of both CRP value and WBC count and only inflammatory findings without malignancy demonstrated by bronchof iberscopy and pulmonary biopsy, while the chest CT disclosed a mass, 5-8cm in diameter, with cavity located in the region of right lower segment 10. At the time of improvement of pulmonary disease, laboratory findings showed an urinary CPR of 2.7μg/day, both fasting and 2-hour postprandial serum CPR of 0.3ng/ml and no response to glucagon stimulation. Therefore, both his basic and postprandial secretion of insulin were recognized to be very low. The value of serum glutamate decarboxylase antibodies was remarkably increased, 3980U/ml, with positive islet-cell antibodies. He had HLA A 24 haplotype which was strongly associated with beta-cell destruction. A diagnosis of late-onset type 1 dibetes mellitus due to autoimmunity was established. Intensive insulin therapy provided inprovement of his glycemic control.