A Case Report of Fulminant Type 1 Diabetes Mellitus Caused by Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Complicated by Iodine-Induced Thyrotoxicosis

Abstract

A 46-year-old woman presented with rash, fever, lymphadenopathy, eosinophilia and liver dysfunction. She had been treated with ornidazole for facial rosacea 2 months previously. Two weeks following presentation, she developed diabetic ketoacidosis with exhausted beta islets (2 h postprandial laboratory values: glucose 22.0 mmol/L, C-peptide < 0.017 nmol/L, proinsulin < 0.23 pmol/L) and negative autoantibodies. Several days thereafter, after having undergone an enhanced computed tomography examination to screen for malignancy, the patient developed thyrotoxicosis with a low iodine absorption rate and super-high urine and serum levels of iodine. The patient was ultimately diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), a hypersensitivity reaction to drugs. Studies have shown that immune dysregulation during DRESS renders patients susceptible to new diseases. Here we report a patient who recovered from DRESS but developed fulminant type 1 diabetes complicated with iodine-induced thyrotoxicosis. This case report sheds light on the pathogenesis of DRESS and its sequelae and illustrates that patients with DRESS require long-term care and follow-up. Electronic supplementary material The online version of this article (10.1007/s13300-019-0607-5) contains supplementary material, which is available to authorized users.