Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report

Nat Metab. 2020 Oct;2(10):1021-1024. doi: 10.1038/s42255-020-00281-8. Epub 2020 Sep 2.

Abstract

Here we report a case where the manifestations of insulin-dependent diabetes occurred following SARS-CoV-2 infection in a young individual in the absence of autoantibodies typical for type 1 diabetes mellitus. Specifically, a 19-year-old white male presented at our emergency department with diabetic ketoacidosis, C-peptide level of 0.62 µg l-1, blood glucose concentration of 30.6 mmol l-1 (552 mg dl-1) and haemoglobin A1c of 16.8%. The patient´s case history revealed probable COVID-19 infection 5-7 weeks before admission, based on a positive test for antibodies against SARS-CoV-2 proteins as determined by enzyme-linked immunosorbent assay. Interestingly, the patient carried a human leukocyte antigen genotype (HLA DR1-DR3-DQ2) considered to provide only a slightly elevated risk of developing autoimmune type 1 diabetes mellitus. However, as noted, no serum autoantibodies were observed against islet cells, glutamic acid decarboxylase, tyrosine phosphatase, insulin and zinc-transporter 8. Although our report cannot fully establish causality between COVID-19 and the development of diabetes in this patient, considering that SARS-CoV-2 entry receptors, including angiotensin-converting enzyme 2, are expressed on pancreatic β-cells and, given the circumstances of this case, we suggest that SARS-CoV-2 infection, or COVID-19, might negatively affect pancreatic function, perhaps through direct cytolytic effects of the virus on β-cells.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Antibodies, Viral / blood
  • Antibodies, Viral / immunology
  • Autoantibodies / blood
  • Autoantibodies / immunology
  • Betacoronavirus* / immunology
  • Biomarkers
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / immunology
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / genetics
  • Diabetes Mellitus, Type 1 / immunology
  • HLA-D Antigens / genetics
  • HLA-D Antigens / immunology
  • Humans
  • Immunoglobulin M / immunology
  • Insulin / metabolism
  • Insulin-Secreting Cells / immunology
  • Insulin-Secreting Cells / metabolism
  • Islets of Langerhans / immunology
  • Male
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / immunology
  • SARS-CoV-2
  • Young Adult

Substances

  • Antibodies, Viral
  • Autoantibodies
  • Biomarkers
  • HLA-D Antigens
  • Immunoglobulin M
  • Insulin