Uncommon Association Between Diabetic Ketoacidosis, Thyrotoxicosis, Cutaneous Abscess and Acute Pericarditis in an Immunocompetent Patient: A Single Case Report and Literature Review

Abstract

Introduction : The typical factors precipitating diabetic ketoacidosis (DKA) include infections (30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis, pericarditis and diabetes mellitus. Case Report : A fifty-year-old Surinamese woman without any medical history was admitted for diabetic ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous abscess. The patient was infected with HTLV-1. Conclusion: To our knowledge, this uncommon association is described for the first time. Few studies have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.

Заболевания, Ассоциированные С Т-Лимфотропным Вирусом Типа 1 Человека (HTLV-1)

“…У пациентов с инфекцией HTLV-1 обнаружили высокую распространенность гипо-и гипертиреоза [40]. Описана инфекция HTLV-1 при тиреоидите [41].…”

Human T-cell leukemia virus type 1 is associated with dysthyroidism in the French Amazon

“…In 1992, a study found an HTLV-1 seroprevalence of 4.4% in pregnant women in western French Guiana, where Maroon ethnic groups predominate ( Carles et al., 2004 ). The description of an association between HTLV-1 infection and hyperthyroidism of unknown etiology in French Guiana led us to expand our investigation to compare the prevalence of hypothyroidism and hyperthyroidism in patients with and without HTLV-1 infection ( Amelie et al., 2020 ).…”