Main Article Content
Diabetic ketoacidosis, SARS-CoV-2, COVID-19, atypical symptoms, ACE 2
Summary. Type 1 diabetes mellitus (T1DM) is rare in infants and toddlers and is usually associated with a relatively high mortality when complicated with diabetic ketoacidosis (DKA). In infants, the classical symptoms of DKA are atypical and therefore many infants with DKA are mistreated for infections. We report a case of DKA precipitated by COVID-19 in an 8-month-old infant with newly diagnosed diabetes mellitus. This case is reported in view of its rarity and originality. The relation between T1DM and COVID19 infection is discussed.
2. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20:689-696.
3. Qian G, Yang N, Ma AHY, et al. A COVID-19 Transmission within a family cluster by presymptomatic infectors in China [published online ahead of print, 2020 Mar 23]. Clin Infect Dis. 2020;ciaa316. doi:10.1093/cid/ciaa316.
4. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181:271-280.
5. Roca-Ho H, Riera M, Palau V, Pascual J, Soler MJ. Characterization of ACE and ACE2 Expression within Different Organs of the NOD Mouse. Int J Mol Sci. 2017;18(3):563. Published 2017 Mar 5. doi:10.3390/ijms18030563.
6. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2017;40(Suppl 1):S62-S69.
7. Barski L, Nevzorov R, Rabaev E, et al. Diabetic ketoacidosis: clinical characteristics, precipitating factors and outcomes of care. Isr Med Assoc J. 2012;14:299-303.
8. Jaeckel E, Manns M, Von Herrath M.Viruses and diabetes. Ann NY Acad Sci.2002; 958:7–25.
9. Roivainen M, Rasilainen S, Ylipaasto P, et al. Mechanisms of coxsackievirus-induced damage to human pancreatic betacells. J Clin Endocrinol Metab.2000; 85:432–440.
10. Ziegler CGK, Allon SJ, Nyquist SK, et al. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell. 2020;181:1016-1035.
11. Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol. 2010;47:193-199.
12.Chee YJ, Ng SJH, Yeoh E. Diabetic ketoacidosis precipitated by Covid-19 in a patient with newly diagnosed diabetes mellitus. Diabetes Res Clin Pract. 2020;164:108166. doi:10.1016/j. diabres.2020. 108166.
13.Carlsson PO, Berne C, Jansson L. Angiotensin II and the endocrine pancreas: effects on islet blood flow and insulin secretion in rats. Diabetologia. 1998;41:127–133.
14. Guo J, Huang Z, Lin L, Lv J. Coronavirus disease 2019 (COVID-19) and cardiovascular disease: a viewpoint on the potential influence of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on onset and severity of severe acute respiratory syndrome Coronavirus 2 infection. J Am Heart Assoc.2020;9(7):e016219. doi:10.1161/JAHA.120.016219.
15. Rubino F, Amiel SA, Zimmet P, et al. New-Onset Diabetes in Covid-19 [published online ahead of print, 2020 Jun 12]. N Engl J Med. 2020;NEJMc2018688. doi:10.1056/NEJMc2018688.