ECE2023 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (159 abstracts)
Covid-induced relapse of exogenous insulin autoimmune syndrome successfully treated with Rituximab and plasmapheresis
Hamdi Frikha , Mouna Mnif , Dhoha Ben Salah , Nesrine Dhieb , Mouna Elleuch , Fatma Mnif , NABILA REKIK Majdoub , Nadia Charfi , Faten Haj Kacem Akid & Mohamed Abid
Hedi Chaker University Hospital, Department of Endocrinology, Sfax, Tunisia
Introduction: Exogenous insulin autoimmune syndrome (EIAS) is a rare cause of hypoglycemia in patients with diabetes treated with exogenous insulin. Flares of auto-immune diseases following covid-19 infection have been widely reported.
Case report: A 15-year-old type 1 diabetes female patient treated with detemir and glulisine was diagnosed with EIAS based on major glycemic instability and an elevated anti exogenous insulin autoantibody titer of 40 IU (NV<0.4), after excluding other differentials. The evolution under high dose oral corticosteroids was favorable. Following a covid-19 infection there was a reappearance of severe nocturnal hypoglycemia and diurnal hyperglycemic phases concomitantly with an elevation of auto-antibody titer. The patient was treated with a course of rituximab 500mg twice followed by three sessions of plasma exchange. A clinical and biological remission was obtained (anti-insulin auto antibodies 4 IU/l).
Discussion: In recent years, the incidence of autoimmune hypoglycemia has gradually increased due to increased administration of exogenous insulin. Beside genetic susceptibility, immunogenicity is influenced by insulin type. There is still no consensus on EIAS management although most of authors recommend corticosteroids and immunosuppressants. Many studies hypothesized that SARS-cov2 may induce auto-immune responses. To our knowledge, this is the first report of EIAS relapse following covid-19 infection.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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