Acute onset of type 1 diabetes accompanied by acute hepatitis C: The potential role of proinflammatory cytokine in the pathogenesis of autoimmune diabetes

A 22-year-old Japanese woman presented with general fatigue. Five days later, she demonstrated a body temperature of 39 °C and a loss in weight of 5 kg. She thereafter became unconscious and was taken to Tomakomai City General Hospital. Urinary ketone body was positive, and plasma glucose was 1063 mg/dl. The serum asparate aminotransferase and alanine aminotransferase levels were 158 and 1220 IU/l, respectively. An arterial blood gas analysis showed metabolic acidosis. Glycated hemoglobin was 10.9%. Urinary C-peptide immnoreactivity was 11 μg/day. Anti-glutamic acid decarboxylase antibody was 12.4 U/ml. In general, islet-associated autoantibodies are detectable several years before the development of overt autoimmune diabetes, thus suggesting that an autoimmune reaction against β-cells had already started in this case. On viral examinations, hepatitis C virus (HCV) antibody was negative, while HCV-RNA was positive. Based on these findings, she was diagnosed to have autoimmune diabetes and acute hepatitis C. In addition, her serum interleukin-18 level was elevated to 506 pg/ml. The duration of diabetic characteristic symptoms before diagnosis is usually several weeks in most cases of autoimmune diabetes. However, it was extremely short in this case. Taken together, these findings suggested that the progression of autoimmune diabetes might have been accelerated due to the infection of HCV.