VIRUS-INDUCED DIABETES-MELLITUS - ISOLATION OF A VIRUS FROM THE PANCREAS OF A CHILD WITHDIABETIC KETOACIDOSIS

A healthy 10-year-old boy was admitted to the hospital in diabetic ketoacidosis within three days of onset of symptoms of a flu-like illness. He died seven days later and post-mortem examination showed lymphocytic infiltration of the islets of Langerhans and necrosis of beta cells. Inoculation of mouse, monkey and human cell cultures with homogenates from the patient's pancreas led to isolation of a virus. Serologic studies revealed a rise in the titer of neutralizing antibody to this virus from less than 4 on the second hospital day to 32 on the day of death. Neutralization data showed that the virus was related to a diabetogenic variant derived from Coxsackievirus B4. Inoculation of mice with the human isolate produced hyperglycemia, inflammatory cells in the islets of Langerhans and beta-cell necrosis. Staining of mouse pancreatic sections with fluorescein-labeled antiviral antibody revealed viral antigens in beta cells. Both the clinical picture and animal studies suggested that the patient's diabetes was virus induced. (N Engl J Med 300:1173–1179, 1979) THE pathogeneses and causes of juvenile-onset diabetes mellitus and maturity-onset diabetes are thought to differ. Juvenile-onset diabetes generally occurs in a younger age group; the onset is more abrupt, and a seasonal incidence has been reported.1 In some patients with juvenile diabetes, especially early in the course of the disease, inflammatory cells have been observed in the islets of Langerhans.2 The number of insulin-producing beta cells is descreased, and insulin is generally required. Moreover, the risk of juvenile-onset diabetes, unlike that of maturity-onset diabetes, is greater in persons with certain HLA types,3 and antibody against islet cells has been found. © 1979, Massachusetts Medical Society. All rights reserved.