Three Cases of Acute Ketotic Diabetes Mellitus with Myocarditis: A Common Viral Origin?

Gibbs, Philip S.

doi:10.1136/bmj.3.5934.781

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…The usual ECG findings of acute myocarditis are inverted, flat, or biphasic T waves and S-T elevation, but it doesn't involve the QRS [2].…”

Section: Case Descriptionmentioning

confidence: 99%

“…Patients presenting with DKA can have subtle ECG changes that include nonspecific ST-T changes which resolve after treatment of the acidosis [1]. The ECG changes usually appear within 24 hours of DKA most common is ST segment depression, although there maybe T wave inversions and prolongation of the QT interval [2], sometimes attributed to be secondary to a viral infection.…”

Section: Introductionmentioning

confidence: 99%

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Myocarditis in a Patient with Diabetic Ketoacidosis: A Case Report

Saeed,

Gupta,

Javaid

2023

MJA

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A case of diabetic ketoacidosis (DKA) complicated by acute myocarditis, which was confirmed by Cardiac MRI. A 27-year-old man with diagnosed type 1 diabetes mellitus was hospitalized with severe DKA, blood sugar on admission was 69.3mmol/l and Hba1c was 104 mmol/mol. The initial ECG showed no acute changes however later he developed ST-T changes on his ECG associated with a significant troponin rise which raised the possibility of Myocarditis. The coronary angiogram ruled out any coronary artery disease, however the diagnosis of Myopericarditis was confirmed based on the echocardiogram findings and cardiac MRI. Viruses are the most common causative agents of myocarditis, our patient described symptoms of fatigue that might indicate the probable underlying viral infection however the excessive alcohol intake and non-compliance with insulin were the contributing factors towards development of diabetic ketoacidosis. The whole viral screen including parvovirus and covid-19 was negative. The Epstein bar virus (EBV) although weekly positive, withminimal viral load couldn't account for the patient's symptoms. Another rare condition that can present with myocarditis is fulminant type 1 diabetes mellitus, which is believed to be non-immune condition causing rapid onset of diabetes mellitus, the exact aetiology is still uncertain, but the presence of islet injury accompanied by myocardial inflammation points towards underlying viral infection as the cause of sudden onset of diabetes mellitus. The auto antibodies for Type 1 DM turn out to be negative in these cases, however in our patient they weren't done because he was a confirmed Type 1 Diabetic. The patient successfully responded to the symptomatic treatment for DKA, implicating that severe DKA was the cause of myocarditis. He was provided education on Type 1 diabetes mellitus and subsequently discharged without any further complications with future outpatient appointment in cardiology clinic.

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“…The usual ECG findings of acute myocarditis are inverted, flat, or biphasic T waves and S-T elevation, but it doesn't involve the QRS [2].…”

Section: Case Descriptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Myocarditis in a Patient with Diabetic Ketoacidosis: A Case Report

Saeed,

Gupta,

Javaid

2023

MJA

View full text Add to dashboard Cite

show abstract

“…Acute JOD has been described in a boy of 18 months who had a high titre of CB2 and of CBspecific IgM (Wilson et al, 1977). Three unrelated young adults developed acute diabetes in association with symptoms suggesting a virus illness (Gibbs, 1974). All 3 had ECG changes suggesting a myocarditis which was assumed viral.…”

Section: Rubella Virusmentioning

confidence: 99%

“…Three unrelated young adults developed acute diabetes in association with symptoms suggesting a virus illness (Gibbs, 1974). All 3 had ECG changes suggesting a myocarditis which was assumed viral.…”

Section: Coxsackie B Virusmentioning

confidence: 99%