LETTER
Insulin-Dependent Diabetes Mellitus Associated with Parvovirus B19 Infection
Akira Kasuga, MD;
Reiko Harada, MD; and
Takao Saruta, MD
15 October 1996 | Volume 125 Issue 8 | Pages 700-701
TO THE EDITOR:
Viruses may play a role in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) [1]. Coxsackievirus P2-C shares homologous sequences with glutamic acid decarboxylase, an autoantigen for IDDM; it has been suggested that this mimicry may trigger autoimmunity. We report a case of IDDM associated with infection with parvovirus B19, which shares homologous sequences with IA-2, another autoantigen for IDDM.
A 21-year-old man developed IDDM after experiencing flu-like symptoms. He subsequently developed a lacy, reticular, erythematous rash that worsened with changes in environmental temperature. These findings are typical of erythema infectiosum. Laboratory findings showed abrupt onset of IDDM, with a plasma glucose level of 313 mg/dL, a hemoglobin A1c value of 8.8%, and a glucagon-stimulated C-peptide level of 1.0 ng/mL.
At admission, IgM antibody against parvovirus B19 and viral DNA was detected; this antibody was no longer detectable after 1 month, at which time IgG antibody appeared. Both the admission and follow-up samples were strongly positive (85th percentile among IDDM sera) for IA-2 antibody, which had been titrated by a radioligand binding assay, and weakly positive (35th percentile) for glutamic acid decarboxylase. In addition, extracellular domains of IA-2 had some amino acid sequences (for example,82 LQGVLRQLMSQGLSWH98 [2]) that mimicked parvovirus B19 (LQGFMTLGIANWLSWE [3]) but glutamic acid decarboxylase did not.
The IA-2 antigen contains approximately 570 amino-acid extracellular domains, whereas glutamic acid decarboxylase is distributed in intracellular vesicles. We speculate that parvovirus B19 infection might prime T-cell clones for the mimicry site, induce autoimmunity against the extracellular domain of IA-2, and ultimately damage the ß-cells.
A large-scale study should be done to further clarify the relation between the pathogenesis of IDDM and parvovirus B19 infection.
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Author and Article Information
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Tokyo Denryoku Hospital, Tokyo, Japan
Keio University School of Medicine, Tokyo, Japan
1. Eisenbarth GS, Ziegler AG, Colman PA. Pathogenesis of insulin-dependent diabetes mellitus. In: Kahn CR, Weir GC, eds. Joslin's Diabetes Mellitus. Malvern, PA: Lea & Febiger; 1994:216-39.
2. Lan MS, Lu J, Goto Y, Notkins AL. Molecular cloning and identification of a receptor-type protein tyrosine phosphatase, IA-2, from human insulinoma. DNA Cell Biology. 1994; 13:505-14.
3. Shade RO, Blundell MC, Cotmore SF, Tattersall P, Astell CR. Nucleotide sequence and genome organization of human parvovirus B19 isolated from the serum of a child during aplastic crisis. J Virol. 1985; 58:921-36.
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