A Case of Fulminant Type 1 Diabetes with Transient Production of Anti-Glutamic Acid Decarboxylase Antibody

Objective: Unusual clinical course Background: Fulminant type 1 diabetes is characterized by a low prevalence of autoantibodies, and was originally described as a nonautoimmune subtype of type 1 diabetes. Herein, we report a case in which we observed the process of extremely rapid onset of diabetes and early decline in anti-glutamic acid decarboxylase (GAD) antibody titers during the inpatient stay. Case Report: A 61 -year -old man was brought to our hospital with marked hyperglycemia (1327 mg/dL), ketonemia (3-hydroxybutyrate: 14 012 mu mol/L), and moderately elevated HbA1c (7.2%) and glycoalbumin (22.3%). C -peptide levels were undetectable. He had suffered from thirst, polyuria, and fatigue for 2 days. Abrupt onset was proven by the clinical data when he visited the hospital with respiratory symptoms 6 days before his admission; plasma glucose, glycoalbumin, C -peptide, and insulin levels were 117 mg/dL, 13.0%, 5.07 ng/mL, and 24.4 mu IU/mL, respectively. The anti -GAD antibody titer measured by enzyme-linked immunosorbent assay was 111 U/mL at admission, 22.8 U/mL 2 weeks after admission, and negative 1 year later. He had a susceptible haplotype DRB1*09: 01-DQB1*03: 03, which is significantly more common in anti -GAD antibody-positive patients with fulminant type 1 diabetes. Conclusions: The early decline of anti -GAD antibody titer likely reflected rapid and complete beta cell loss. The sequential metabolic and immunological observation in this case may provide insight into the pathogenesis of fulminant type 1 diabetes.