16 May 2024
: Case report 
A Case of Fulminant Type 1 Diabetes with Transient Production of Anti-Glutamic Acid Decarboxylase Antibody
Unusual clinical course, Challenging differential diagnosis
Naka Harada12ABDEF, Hitomi Nakayama12ABCDEF*, Masatoshi Nomura
3CF
DOI: 10.12659/AJCR.943590
Am J Case Rep 2024; 25:e943590
Table 1. Laboratory findings at admission.
| Test | Value | Reference range |
|---|---|---|
| Red blood cell | 433×10/µL | 435–555 |
| Hemoglobin | 13.8 g/dL | 13.7–16.8 |
| Hematocrit | 44.20% | 40.7–50.1 |
| White blood cell | 11,400/µL | 3,300–8,600 |
| Platelet | 20.1×10/µL | 15.8–34.8 |
| Casual plasma glucose | 1,327 mg/dL | 73–109 |
| Plasma osmolarity | 359 mOsm/kgHO | 276–292 |
| Sodium | 118 mEq/L | 138–145 |
| Potassium | 5.3 mEq/L | 3.6–4.8 |
| Chloride | 79 mEq/L | 101–108 |
| Calcium | 9.0 mg/dL | 8.8–10.1 |
| Phosphate | 8.1 mg/dL | 2.7–4.6 |
| Uric acid | 11.4 mg/dL | 3.7–7.8 |
| Aspartate aminotransferase | 103 U/L | 13–30 |
| Alanine aminotransferase | 63 U/L | 10–42 |
| Lactate dehydrogenase | 292 U/L | 124–222 |
| Alkaline phosphatase | 270 U/L | 106–322 |
| γ-Glutamyl transpeptidase | 39 U/L | 13–64 |
| Total protein | 6.3 g/dL | 6.6–8.1 |
| Albumin | 4.0 g/dL | 4.4–5.1 |
| Urea nitrogen | 70.5 mg/dL | 8.0–20.0 |
| Creatinine | 1.44 mg/dL | 0.65–1.07 |
| Creatine kinase | 3,287 IU/L | 59–248 |
| Creatine kinase-MB | 106 IU/L | 0.0–24.9 |
| C-reactive protein | 1.34 mg/dL | 0.00–0.14 |
| Amylase | 244 U/L | 44–132 |
| Lipase | 33 U/L | 11–59 |
| Trypsin | 343 ng/mL | 210–570 |
| Elastase | 1140 ng/dL | ≤300 |
| Phospholipase A2 | 511 ng/dL | 130–400 |
| Total cholesterol | 210 mg/dL | 142–248 |
| Triglyceride | 404 mg/dL | 40–234 |
| Lactate | 29.2 mg/dL | 3.0–17.0 |
| Acetoacetic acid | 3,023 µmol/L | <55 |
| 3-Hydroxybutyrate | 14,012 µmol/L | <85 |
| HbA1c | 7.20% | 4.9–6.0 |
| Glycoalbumin | 22.30% | 12.3–16.9 |
| pH | 7.192 | 7.35–7.45 |
| PO | 120.0 mmHg | 83–108 |
| PCO | 18.6 mmHg | 35–48 |
| Bicarbonate | 6.9 mEq/L | 22–26 |
| Base excess | −20.1 mEq/L | −3.2–1.8 |
| Specific gravity | 1.021 | 1.005–1.030 |
| Glucose | (4+) | |
| Protein | (–) | |
| Ketone bodies | (2+) | |
| C-peptide | <0.03 ng/mL | 0.8–2.5 |
| TSH | 0.258 µIU/mL | 0.4–4.9 |
| Free T4 | 0.81 ng/dL | 0.7–1.5 |
| Anti-thyroglobulin antibody | <10 IU/mL | <28 |
| Anti-thyroidperoxidase antibody | <9 IU/mL | <16 |
| Anti-GAD antibody | 111 U/mL | <5.0 |
| Anti-IA-2 antibody | <0.6 U/mL | <0.6 |
| Anti-nuclear antibody | <5.0 IU/mL | ≤5 |
| IgG | 955 mg/dL | 870–1,700 |
| IgA | 305 mg/dL | 110–410 |
| IgM | 84 mg/dL | 33–190 |
| Hepatitis C virus | (–) | |
| Hepatitis A virus-IgM | (–) | |
| Hepatitis A virus-IgG | (–) | |
| Cytomegalovirus-IgM | (–) | |
| Cytomegalovirus-IgG | (+) | |
| Epstein-Barr virus-IgM | (–) | |
| Epstein-Barr virus-IgG | 40 | |
| Epstein-Barr virus-EBNA | 20 | |
| Adenovirus | (–) | |
| Influenza virus | (–) |