Abstract
Here we report a case where the manifestations of insulin-dependent diabetes occurred following SARS-CoV-2 infection in a young individual in the absence of autoantibodies typical for type 1 diabetes mellitus. Specifically, a 19-year-old white male presented at our emergency department with diabetic ketoacidosis, C-peptide level of 0.62 µg l–1, blood glucose concentration of 30.6 mmol l–1 (552 mg dl–1) and haemoglobin A1c of 16.8%. The patient´s case history revealed probable COVID-19 infection 5–7 weeks before admission, based on a positive test for antibodies against SARS-CoV-2 proteins as determined by enzyme-linked immunosorbent assay. Interestingly, the patient carried a human leukocyte antigen genotype (HLA DR1-DR3-DQ2) considered to provide only a slightly elevated risk of developing autoimmune type 1 diabetes mellitus. However, as noted, no serum autoantibodies were observed against islet cells, glutamic acid decarboxylase, tyrosine phosphatase, insulin and zinc-transporter 8. Although our report cannot fully establish causality between COVID-19 and the development of diabetes in this patient, considering that SARS-CoV-2 entry receptors, including angiotensin-converting enzyme 2, are expressed on pancreatic β-cells and, given the circumstances of this case, we suggest that SARS-CoV-2 infection, or COVID-19, might negatively affect pancreatic function, perhaps through direct cytolytic effects of the virus on β-cells.
【초록키워드】 COVID-19, antibody, SARS-COV-2 infection, Diabetes Mellitus, risk, virus, Antigen, serum, Haemoglobin, cells, male, Patient, Genotype, Autoimmune, receptors, HLA, insulin, Admission, islet, C-peptide, Concentration, blood glucose, manifestation, autoantibody, β-cells, leukocyte, glutamic acid, Diabetic, SARS-CoV-2 entry, Positive test, SARS-CoV-2 protein, Effect, Affect, enzyme-linked immunosorbent, occurred, carried, the patient, elevated, absence, expressed, diabete, cytolytic, insulin-dependent diabete, pancreatic, pancreatic β-cell, probable COVID-19 infection, tyrosine phosphatase, 【제목키워드】 SARS-CoV-2, Case report, insulin-dependent diabete,