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Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report
BACKGROUND: Cyclophosphamide may induce autoimmune diabetes through a decrease in suppressor T cells and increase of proinflammatory T helper type 1 response in animal models. In humans, this association is not as clear due to the presence of other risk factors for hyperglycemia, but it could be a p...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287356/ https://www.ncbi.nlm.nih.gov/pubmed/30526658 http://dx.doi.org/10.1186/s13256-018-1925-3 |
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author | García-Sáenz, Manuel Uribe-Cortés, Daniel Ramírez-Rentería, Claudia Ferreira-Hermosillo, Aldo |
author_facet | García-Sáenz, Manuel Uribe-Cortés, Daniel Ramírez-Rentería, Claudia Ferreira-Hermosillo, Aldo |
author_sort | García-Sáenz, Manuel |
collection | PubMed |
description | BACKGROUND: Cyclophosphamide may induce autoimmune diabetes through a decrease in suppressor T cells and increase of proinflammatory T helper type 1 response in animal models. In humans, this association is not as clear due to the presence of other risk factors for hyperglycemia, but it could be a precipitant for acute complications. CASE PRESENTATION: A 31-year-old Mestizo-Mexican woman with a history of systemic lupus erythematosus presented with severe diabetic ketoacidosis, shortly after initiating a multi-drug immunosuppressive therapy. She did not meet the diagnostic criteria for type 1 or type 2 diabetes and had no family history of hyperglycemic states. She persisted with hyperglycemia and high insulin requirements until the discontinuation of cyclophosphamide. After this episode, she recovered her endogenous insulin production and the antidiabetic agents were successfully withdrawn. After 1 year of follow up she is still normoglycemic. CONCLUSION: Cyclophosphamide may be an additional risk factor for acute hyperglycemic crisis. Glucose monitoring could be recommended during and after this treatment. |
format | Online Article Text |
id | pubmed-6287356 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62873562018-12-14 Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report García-Sáenz, Manuel Uribe-Cortés, Daniel Ramírez-Rentería, Claudia Ferreira-Hermosillo, Aldo J Med Case Rep Case Report BACKGROUND: Cyclophosphamide may induce autoimmune diabetes through a decrease in suppressor T cells and increase of proinflammatory T helper type 1 response in animal models. In humans, this association is not as clear due to the presence of other risk factors for hyperglycemia, but it could be a precipitant for acute complications. CASE PRESENTATION: A 31-year-old Mestizo-Mexican woman with a history of systemic lupus erythematosus presented with severe diabetic ketoacidosis, shortly after initiating a multi-drug immunosuppressive therapy. She did not meet the diagnostic criteria for type 1 or type 2 diabetes and had no family history of hyperglycemic states. She persisted with hyperglycemia and high insulin requirements until the discontinuation of cyclophosphamide. After this episode, she recovered her endogenous insulin production and the antidiabetic agents were successfully withdrawn. After 1 year of follow up she is still normoglycemic. CONCLUSION: Cyclophosphamide may be an additional risk factor for acute hyperglycemic crisis. Glucose monitoring could be recommended during and after this treatment. BioMed Central 2018-12-10 /pmc/articles/PMC6287356/ /pubmed/30526658 http://dx.doi.org/10.1186/s13256-018-1925-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report García-Sáenz, Manuel Uribe-Cortés, Daniel Ramírez-Rentería, Claudia Ferreira-Hermosillo, Aldo Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title | Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title_full | Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title_fullStr | Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title_full_unstemmed | Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title_short | Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
title_sort | difficult-to-diagnose diabetes in a patient treated with cyclophosphamide – the contradictory roles of immunosuppressant agents: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287356/ https://www.ncbi.nlm.nih.gov/pubmed/30526658 http://dx.doi.org/10.1186/s13256-018-1925-3 |
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