Type 1 Diabetes Mellitus with Dual Autoimmune Mechanism Related to Pegylated Interferon and Ribavirin Treatment for Chronic HCV Hepatitis

Type 1 Diabetes Mellitus with Dual Autoimmune Mechanism Related to Pegylated Interferon and Ribavirin Treatment for Chronic HCV Hepatitis
 

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Cristina Popescu^{1, 2}, Gabriel-Adrian Popescu^{1, 2}, Victoria Arama^{1, 2}

1) "Prof. dr. Matei Bals" National Institute of Infectious Diseases
2) "Carol Davila" University of Medicine and Pharmacy Bucharest Romania

Abstract

We report a case of type 1 diabetes mellitus during pegylated interferon and ribavirin treatment for chronic
hepatitis C, in a young man previously diagnosed with Hashimoto's thyroiditis and vitiligo. The diabetes
mellitus occurred during the 12th month of therapy and the cessation of interferon was necessary. Besides
anti-islet autoantibodies our patient had also anti-insulin receptor autoantibodies, which explains the type
B insulin resistance. One year after interferon discontinuation the patient continues insulin treatment and
all the pancreatic autoantibodies are still positive. Patients with autoimmune disorders should be closely
monitored and periodically tested for pancreatic autoantibodies during interferon treatment, even in the
absence of hyperglycemia.

Key words: type 1 diabetes mellitus - interferon-alpha side effects - insulin resistance - hepatitis.

Abbreviations: AIRA - anti-insulin receptor autoantibodies; APS - autoimmune polyglandular syndrome; cANCA - classical antineutrophil cytoplasmic antibodies; DM - diabetes mellitus; DNA - deoxyribonucleic acid ; FT4 - free thyroxin; GAD Ab - glutamic acid decarboxylase antibodies; HbA1c - glycated haemoglobin; HCV - hepatitis C virus; HLA - human leukocyte antigen; IA-2 Ab- insulinoma associated antigen 2 antibodies; IAA - insulin autoantibodies; ICA - islet cell autoantibodies; NK - natural killer; PAA - pancreatic associated autoantibodies; pANCA- protoplasmic-staining antineutrophil cytoplasmic antibodies; T1DM - type 1 diabetes mellitus; TNF - tumor necrosis factor; TSH - thyroid-stimulating hormone; VL - viral load; ZnT8 Ab - zinc transporter-8 autoantibodies; IL2 - interleukin 2; IL10 - interleukin 10.