Journal Article

Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report

Hollstein, Tim, Ziegler, Anette G., Bonifacio, Ezio, Wendorff, Mareike, Schulte, Dominik M., Schreiber, Stefan, Laudes, Matthias, Franke, Andre, Glück, Andreas, Schulz, Juliane, Bornstein, Stefan R.

2020

Overview

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. The authors report the case of a young patient who displayed insulin-dependent diabetes after SARS-CoV-2 infection in the absence of autoantibodies indicative of autoimmune type 1 diabetes.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/326/596/4130 / 631/443/319/1642/137/1418 / 692/163/2743/137/1418 / ACE2 / Angiotensin / Angiotensin-converting enzyme 2 / Antibodies / Antibodies, Viral - blood / Antibodies, Viral - immunology / Autoantibodies / Autoantibodies - blood / Autoantibodies - immunology / Beta cells / Betacoronavirus - immunology / Biomarkers / Biomedical and Life Sciences / Blood / Blood levels / Case reports / Coronavirus Infections - complications / Coronavirus Infections - diagnosis / Coronavirus Infections - immunology / COVID-19 / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetes Mellitus, Type 1 - diagnosis / Diabetes Mellitus, Type 1 - genetics / Diabetes Mellitus, Type 1 - immunology / Diabetic ketoacidosis / Emergency medical care / Enzyme-linked immunosorbent assay / Fatigue / Genotypes / Glutamate decarboxylase / Glutamic acid / Glycoproteins / Hemoglobin / Histocompatibility antigen HLA / HLA-D Antigens - genetics / HLA-D Antigens - immunology / Humans / Hyperglycemia / Immunoglobulin M - immunology / Infections / Insulin / Insulin - metabolism / Insulin-Secreting Cells - immunology / Insulin-Secreting Cells - metabolism / Islet cells / Islets of Langerhans - immunology / Ketoacidosis / Letter / Life Sciences / Male / Pancreas / Pandemics / Parents & parenting / Patients / Peptidyl-dipeptidase A / Pneumonia, Viral - complications / Pneumonia, Viral - diagnosis / Pneumonia, Viral - immunology / Protein-tyrosine-phosphatase / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Viral infections / Viruses / Young Adult