Endocrine Abstracts

People with diabetes are at increased risk for developing tuberculosis than non-diabetics. We presented a patient with recurrent diabetic ketoacidosis who was later diagnosed with pulmonary tuberculosis.

Case: A 22 year old male with type 1 diabetes for nine years was admitted to the emergency service due to nausea and vomiting. Detecting high anion gap with metabolic acidosis in his blood gas), and ketones in urine analysis,the patient was hospitalized for diabetic ketoacidosis (DKA). Additional analysis of urine, liver, kidney tests, abdominal ultrasound, chest X-ray were within normal limits. Lumbosacral MR imaging based on the low back pain did not reveal any pathology. Serological tests of celiac disease was negative. After receiving intravenous insulin, DKA resolved and he was discharged. 1 week later, the patient admitted to our hospital because of high anion gap metabolic acidosis and hyperglycemia. The cortisol and anterior hypophysis hormones made for the etiology of DKA were within normal range. Recommending outpatient clinic control the patient was discharged. For the third time, after another nausea, vomiting and abdominal pain, the patient was referred to another health center with diabetes ketaoacidosis; gastroscopy was performed and esophageal lineer ulcers were detected. Pathology was compatible with non-specific inflammation. After being discharged, the patient was presented again to our emergency department suffering from chest pain, retrosternal burning and weight loss. Again ketoacidosis was detected and hospitalized. During his admission, chest X-ray revealed right upper lobe cavitary lung lesion. With positive sputum acid-fast bacilli(AFB) stains he was diagnosed and treated for pulmonary tuberculosis.

Discussion: The tuberculosis incidence in diabetes is four times higher than general population. Especially in the developing countries like Turkey where the prevalence of type 2 DM is increasing, tuberculosis is an important health problem and patients with diabetes should be screened for tuberculosis.