Title:Uncommon Association Between Diabetic Ketoacidosis, Thyrotoxicosis, Cutaneous Abscess and Acute Pericarditis in an Immunocompetent Patient: A Single Case Report and Literature Review
Volume: 16
Issue: 6
Author(s): Martinot Amelie, Demar Magalie, Thelusme Liliane, Bounoua Merzaka, Santa Florin, Dueymes Maryvonne, Vujica Jelena, Dequidt Henry and Sabbah Nadia*
Affiliation:
- Service d’Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne,French Guiana
Keywords:
Diabetes mellitus, diabetic ketoacidosis, thyroiditis, acute pericarditis, infection, human T lymphotropic virus
type 1.
Abstract:
Introduction: The typical factors precipitating diabetic ketoacidosis (DKA) include infections
(30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The
etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe
thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T
lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated
with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an
endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis,
pericarditis and diabetes mellitus.
Case Report: A fifty-year-old Surinamese woman without any medical history was admitted for diabetic
ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was
low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context
of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous
abscess. The patient was infected with HTLV-1.
Conclusion: To our knowledge, this uncommon association is described for the first time. Few studies
have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not
find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies
are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.
