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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2022; 05(02): 087-088
DOI: 10.1055/s-0042-1757703
Clinical Vignette

A Case of Diabetes Mellitus Treated with Glucocorticoids

L. N. Rao Bondugulapati 
1   Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
,
Hussam Abusahmin
2   Department of Endocrinology, Al Qassimi Hospital, Sharjah, United Arab Emirates
,
Peter J. T. Drew
3   Department of Medicine, Wrexham Maelor Hospital, Wrexham, United Kingdom
,
David K. W. Watson
3   Department of Medicine, Wrexham Maelor Hospital, Wrexham, United Kingdom
,
Anthony N. Dixon
3   Department of Medicine, Wrexham Maelor Hospital, Wrexham, United Kingdom
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Clinical Resume

A 55-year-old man presented to his general practitioner (GP) with a 3-week history of flu-like symptoms, pruritis, weight loss, and diarrhea. Initial investigations showed eosinophilia, 32.2 × 109/L (normal range: 0 to 0.5 × 109/L) and a normal random glucose.

He was seen in a general medical clinic 3 weeks after the initial referral from GP and, at this point, had polyuria and polydipsia. He was previously well and was on no medication. He is a nonsmoker, drinks alcohol occasionally, and denies illicit drug abuse. There had been no recent travel abroad. Physical examination was unremarkable.

Repeat investigations showed ongoing eosinophilia (33.5 × 109/L), elevated random blood glucose (15.9 mmol/L), raised hemoglobin A1c (HbA1c) (89 mmol/mol, i.e., 10.3%), raised creatinine (171 µmol/L; 1.93 mg/dL), and normal liver function tests. There were no ova, cysts, or parasites in urine or stool. Strongyloides, hepatitis, and human immunodeficiency virus serology were negative, as were the antinuclear antibody and antineutrophil cytoplasmic autoantibody. A cytogenetic analysis test and F1P1L1-PDGFRA (to rule out eosinophilic leukemia) were also negative. Renal function normalized with intravenous fluid support. Acute kidney injury was thought to be secondary to diarrhea and osmotic diuresis. Computed tomography (CT) scan of the chest and abdomen showed a generally swollen and bulky pancreas ([Fig. 1]).

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Fig. 1 Computed tomography of the abdomen, abdomen shows an enlarged pancreas.


Publication History

Article published online:
02 December 2022

© 2022. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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