Association between diabetes mellitus and sarcoidosis: a case report
A. Bulgar1, A. Brehar1, D. Paun1, A. Cojocaru2 & C. Dumitrache1
Introduction: Sarcoidosis is a multisystemic inflammatory disease of unknown etiology, characterized by noncaseating granulomas, predominantly in the lymph nodes, lungs, eyes and skin, although any organ may be involved.
Sarcoidosis may also be associated with endocrine autoimmune diseases such as type 1 diabetes, autoimmune thyroiditis.
Case report: We present a case of a 24-year-old young man who was diagnosed in August 2010 with type 1 diabetes mellitus with a fasting plasma glucose value over 300 mg/dl. We initiated insulinotherapy with biphasic insulin aspart 30/70 22 units per day for 6 month and then insuline Glargine 26 units per day because the patient refused intensive insulin treatement. After 2 month the patient complained of chest pain and dispnoea. The chest radiography showed bilateral hilar limphadenopathy and the chest computed tomography (CT) reveald many mediastinal adenopathy (1.72.5 cm) and some hilar adenopathy (3 cm). A tuberculin skin test was nonreactive. Serum ACE level measured at 36.7 μ/ml (normal: 1528 μ/ml). The performed tests infirmed tuberculosis diagnosis. Bronchoscopy: bilateral diffuse bronchitis aspect without active lesions or mucosal proliferative elements.
Bronchial aspirate revealed isolated and grouped cylindrical epithelium, squamous epithelium, posters of squamous metaplastic epithelium, relatively frequent macrophages and lymphocytes, rare neutrophils. After the diagnosis of sarcoidosis grade III the patient was treated with NSAIDs because corticotherapy would be negatively affected glycemic status.
Conclusion: The association between type 1 diabetes and sarcoidosis is rare and the question is if sarcoidosis was caused by the therapy with insuline Glargine. Patient should be followed up for other autoimmune diseases as sarcoidosis may be associated with autoimmune hemolytic anemia, autoimmune idiopathic thrombocythaemia, Sjogrens syndrome, autoimmune thyroid disease.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.