A Case of Autoimmune Polyglandular Syndrome Type 3 (APS Type 3) With Diabetic Ketoacidosis and Hyperthyroidism Accompanied With Early Disappearance of Disease-Specific Antibodies

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  • 複数の疾患特異的自己抗体の早期陰性化を認めた多腺性自己免疫症候群3型の1例

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Abstract

A 46-year-old woman was admitted to another hospital due to a fever, abdominal pain, and persist vomiting for several days. The next day, she was transferred to our hospital on suspicion of diabetic emergency. A laboratory examination showed elevated levels of white blood cells, C-reactive protein, plasma glucose and ketone bodies with metabolic acidosis and hyperthyroidism. Under a diagnosis of diabetic ketoacidosis and severe hyperthyroidism, an intravenous insulin infusion with oral administration of methimazole and iodine potassium was started immediately. Antibiotic treatment was added, because enhanced computed tomography revealed pelvic peritonitis. After her general condition ameliorated with the resolution of the above-mentioned pathologies, she was discharged with multiple daily insulin injections. She was diagnosed with type 1 diabetes and Graves' disease according to positive islet cell-related antibodies and thyrotropin receptor antibody, which constitute autoimmune polyglandular syndrome (APS) type 3. On screening for other antibodies, cyclic citrullinated peptide antibody and anti-mitochondrial M2 antibody were detected on admission, but both disappeared soon after discharge. We herein report a case of APS type 3 with diabetic ketoacidosis and hyperthyroidism complicated by a spontaneous disappearance of disease-specific antibodies. The pathogenesis of this rare case is also discussed.

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