Postmortem Diagnosis of Fulminant Type 1 Diabetes Mellitus: Case Report

摘要

Abstract We herein report a case of sudden death in a 20s male who presented with fever 1 week before and with abdominal pain and vomiting 2 days before death. Laboratory findings at the time of death were suspected the onset of fulminant type 1 diabetes accompanied by diabetic ketoacidosis and acute renal failure. A postmortem blood examination at several sites showed elevated levels of glucose and β-hydroxybutyrate, lower levels of C-peptide, insulin, 1,5-anhydroglucitol, and HbA1c of less than 8.7% based on the diagnostic criteria of FT 1DM. Furthermore, glucose levels in vitreous humor and cerebrospinal fluid were very high. These results showed reflecting antemortem hyperglycemia. Postmortem serum pancreatic enzyme levels of lipase and elastase 1 were high. Antibodies to insulin, insulinoma-associated antigen-2 (IA-2), and zinc transporter 8 (ZnT8) were negative, while antibodies to glutamic acid decarboxylase (GAD) slightly exceeded the reference range (< 1.5 U/mL). Immunostaining of insulin in pancreatic tissue showed no positive cells in contrast to glucagon. We presented that FT1DM was diagnosed even 3 days postmortem, as compared with the antemortem clinical examination.