Congenital rubella infection is a transplacental infection that can cause intrauterine growth retardation, cataract, patent ductus arteriosus, hearing loss, microcephaly, thrombocytopenia and severe fetal injury. It has been shown that type 1 diabetes mellitus develops in 1220% of patients with congenital rubella infection and disorder in oral glucose tolerance test is observed in 40%. A 13-year-old male patient presented with complaints of new-onset polydipsia, urination, and weight loss. From 3 months old, he was diagnosed with patent ductus arteriosus in pediatric cardiology department and he was found to have neurosensory hearing loss from birth. On physical examination, weight was 42.7 kg (2550p), height was 153.2 cm (25-50 p), head circumference was 46 cm (<3p), 2/6 cardiac murmur and hearing aid were present. Blood glucose was 619 mg/dl, urine ketone was +3, blood gas shows metabolic acidosis, insulin was 4.1 IU/ml (218) and serum C-peptide level was 1.23 ng/ml (1.14.4). HbA1c value was 15.9%, anti insulin antibody was 0.78 U/ml (00.5 U), anti-GAD was 22.8 U/ml (<1 U/ml) and islet cell antibody was positive. Intravenous fluid and insulin therapy was started according to the degree of dehydration with the diagnosis of immune-mediated type 1 diabetes mellitus. Subcutaneous insulin therapy was switched to 1.2 units/kg per day after the patients metabolic acidity was corrected and blood glucose regulation was achieved. Immune-mediated type 1 diabetes was thought to be associated with congenital rubella infection due to patent ductus arteriosus, microcephaly, and neurosensory hearing loss following a febrile and rash illness of the mother during pregnancy. Immune-mediated type 1 diabetes mellitus associated with congenital rubella infection should be assessed and followed up with a multidisciplinary approach. Early diagnosis and appropriate treatment will prevent the development of complications.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology