Diabetes mellitus, type case report

In patients with chronic hepatic B or C the respective prevalences of pancreatic autoantibodies increased from 2% and 3% at baseline to 5% and 7% after interferon (544). In all, 31 published cases of type 1 diabetes mellitus attributed to interferon alfa treatment were detailed, mostly in patients with hepatitis C. Irreversible diabetes required permanent insulin treatment in all but eight cases. At least one marker of pancreatic autoimmunity was positive in nine of 18 patients before treatment, and in 23 of 30 patients at the onset of diabetes. In accordance with these results and the likelihood of a genetic predisposition, the authors recommended screening for islet cell and glutamic acid decarboxylase autoantibodies before and during interferon alfa treatment. However, owing to the low number of reported cases and the paucity of studies that have examined the relation between pancreatic autoimmunity and the occurrence of diabetes, further research on the predictive potential of such a systematic investigation is warranted. 

Hypoglycemia has uncommonly been reported with levofloxacin and appears to occur most often in elderly patients with type 2 diabetes mellitus who are taking oral hypoglycemics. A new case has been reported (597). 

Autoimmune diseases have been reported to be more frequent in human subjects treated with several recombinant cytokines [38], For instance, increased titers or the new occurrence of autoantibodies have been observed in hepatitis C patients treated with the recombinant interferons-alpha (IFNa). Quite a few clinical case reports describe the development of organ-specific as well as systemic autoimmune diseases including systemic lupus erythematosus, insulin-dependent type I diabetes mellitus, autoimmune thrombocytopenia, autoimmune hemolytic anemia, myasthenia gravis, and autoimmune thyroiditis in patients under IFNa therapy. Although the mechanism involved is not fully elucidated, the available data support the pathogenic potential of IFNa in autoimmunity [31]. In contrast, autoimmune effects associated with IFNp therapy are thought to be of lesser concern based on the current clinical evidence [38], Thyroid autoimmunity in contrast to other autoimmune diseases is frequent in patients treated with recombinant interleukin-2 (rIL-2). Thus, among 281 previously euthyroid cancer patients treated with rIL-2, up to 41%... 

Type I diabetes mellitus and thyroid disease reportedly develop in 0.08-2.6% and 10-15% of patients treated with combined interferon alfa- -ribavirin for chronic hepatitis C but rarely coexist however, both conditions have been reported in a 33-year-old woman [50 ]. In another case, a 55-year-old woman developed type 1 diabetes and had a recurrence of Graves disease during treatment with peginterferon alfa -I- ribavirin for chronic hepatitis C [51 ]. There were serum anti-glutamic acid decarboxylase antibodies and the authors suggested that she had autoimmune polyglandular syndrome type III. 

A case summary reports on two cases of neutropenia following the administration of febuxostat for the treatment of hyperuricemia in patients with chronic kidney disease. According the Naranjo probability scale (assessing the causality between exposure and outcome) febuxostat was the probable cause of neutropenia. A 74-year-old woman with liver cirrhosis and chronic kidney disease developed neutropenia 11 days after febuxostat (10 mg daily) administration. A 68-year-old man with type 2 diabetes mellitus on intermittent haemodialysis developed neutropenia only 3 days after febuxostat treatment (10 mg daily). In both cases after discontinuation of febuxostat and treatment with granulocyte colony-stimulating factor, neutrophil counts returned to normal [62 ]. 

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