Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
Keywords:
Wegener’s Granulomatosis, Diabetes mellitus, hyperglicemic hiperosmolar state, corticosteroids, cyclophosphamide, vasculitiAbstract
We describe a clinical case of a 43 year-old-man recurring to
Emergency Department with persistent arthralgias and acute
renal failure. A recent hospital admission due to communityacquired pneumonia with pleural effusion and irregular nodules
in Computed Tomography (CT) scan was noticeable. Study of renal
failure revealed pauci-imune necrotizing nephropathy with positive
anti-proteinase 3 ANCA (PR3-ANCAs) establishing the diagnosis
of Wegener’s Granulomatosis. He began treatment with prednisolone and cyclophosphamide (CFA), being released from hospital
clinically improved. Ten days after discharge, he was readmitted
to hospital because of a hyperglicemic hyperosmolar state. Even
with dose reduction of steroids and CFA, long term therapy with
insulin in order to obtain glicemic control was needed.
Such presentation of diabetes mellitus as hyperglicemic
hyperosmolar state within few days after beginning therapy with
steroids in a previously normoglicemic patient is rare. We believe
that CFA had an important role in this patient with propensity to
auto-immunity phenomena. Similar to what happens in rats and
already shown also in humans, CFA might have selected a clone of
auto-reactive T-cells that promoted the auto-immune destruction
of β-pancreatic cells.
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