A Case of Fulminant Type 1 Diabetes Mellitus with Hematemesis Caused by a Massive Acute Upper Gastrointestinal Mucosal Lesion

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  • 広範な上部消化管急性粘膜病変により吐血をきたした劇症1型糖尿病の1例
  • 症例報告 広範な上部消化管急性粘膜病変により吐血をきたした劇症1型糖尿病の1例
  • ショウレイ ホウコク コウハン ナ ジョウブ ショウカカン キュウセイ ネンマク ビョウヘン ニ ヨリ トケツ オ キタシタ ゲキショウ 1ガタ トウニョウビョウ ノ 1レイ

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A 51-year-old man seen for high fever, thirst, polyposia, polyuria, and general malaise on January 25, 2002, was brought 6 days later to the emergency room with hematemesis. Laboratory data on admission was as follows : plasma glucose, 697 mg/dl ; pH 7.12 ; HbA1c, 6.0% ; and elevated serum pancreatic enzyme (elastase 1, 2,610 ng/dl ; pancreatic phospholipase A2, 1,390 ng/dl). Urinary C-peptide was not detected and anti-GAD antibody was negative. These findings suggested a diagnosis of fulminant type 1 diabetes, and insulin therapy was begun. Endoscopy showed wide-ranging mucosal erosion with hemorrhage in all surrounding tissues from the esophagus to the stomach and the duodenum, so intravenous hyperalimentation (IVH) and H2 blocker were administered. Although abdominal symptoms appear at high frequency with fulminant type 1 diabetes, this case is unique in that it includes severe symptoms such as hemorrhage and acute wide-ranging mucosal erosion in the upper gastrointestinal tract.

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