Development of fulminant Type 1 diabetes with thrombocytopenia after influenza vaccination: a case report.
Diabet Med. 2011 Jul 22. Epub 2011 Jul 22. PMID: 21781156
Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine Division of Integrated Medical Education, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine Diabetes Center, Mahoshi Hospital, Kobe, Japan.
Case Report: A 54-year-old man was admitted to the hospital with diabetic ketosis due to hyperglycemia. He had been in good health without history of hyperglycemia. Seven days before admission, he received influenza vaccination. Four days after vaccination, he had general fatigue, thirst and polyuria withoutflu-like symptom. On admission, he showed body weight loss for a couple of days, blood glucose was 29.0mmol/l and HbA1c 40 mmol/mol (5.9%). Fasting and 2h- C Peptide immunoreactivity values were<0.0333nmol/L and 0.0999nmol/L, respectively. GAD Ab and IA-2 Ab were negative, so no autoimmunity seemed to participate in the etiology. HLA genotypes were consistent with susceptibility to fulminant type 1 diabetes. Taken together, he was diagnosed as fulminant type 1 diabetes. In addition, ELISPOT assay also showed no association with T cell-mediated autoimmunity. Conclusion: This is the first description of fulminant type 1 diabetes after influenza vaccination. Our observation raises the possibility that influenza vaccination might trigger this condition via the TLR7 pathway.