慢性甲状腺炎および自己免疫性肝炎を合併した高齢発症1型糖尿病の1例

Abstract

A case of type 1 diabetes mellitus with elderly onset accompanied by chronic thyroiditis and autoimmune hepatitis is reported. The patient was a 76-year-old woman, referring to our hospital for hypothyroidism due to chronic thyroiditis and receiving medication made of thyroid hormone since 1994. She was conscious of intense thirst on suffering from influenza-like symptoms in 1998. She was admitted to our hospital because of a high level of plasma glucose (450 mg/dL), diagnosed with type 1 diabetes mellitus by a thorough examination, and treated with insulin therapy. But the control of plasma glucose was very poor after that, so she was admitted to our hospital for the purpose of the control of plasma glucose on May 20, 2002. On the 9th hospital day, blood examination revealed liver dysfunction with an AST level of 281IU/L and an ALT level of 193IU/L. A liver biopsy was not performed because of objections by the patient and her family, but we diagnosed this case as autoinrmune hepatitis because the antinuclear antibody was positive (1,280×), the level of IgG was high (2,048mg/dL), and the viral markers were negative. On the 40th hospital day, treatrnent by prednisolone was begun at the dose of 30mg/day. After that the liver dysfUnction improved, and she was discharged on the 85th hospital day.