Endocrine Abstracts

A 19-year-old gentleman was brought to the emergency department found collapsed at home. X-Ray of his chest revealed cavitating lesions within the lung fields. This was on a background history of type 1 diabetes mellitus. HbA1c was 116 mmol/mol which was indicative of chronically poor control. Diabetes was diagnosed at age 13 yet the patient had never attended a scheduled appointment with the diabetes services, however he did frequently present with diabetic ketoacidosis to the emergency department. A contributing factor to the patient’s poor diabetes control had been identified as deprivation, considered extremely disadvantaged as per HP deprivation indices 2022 (www.pobal.ie). CT thorax revealed bilateral cavitating lung lesions. Acid-fast bacilli were seen on sputum sampling and culture confirmed mycobacterium tuberculosis with no resistance. He has no infected contacts. The patient was hospitalized for 6 weeks of anti-tuberculosis treatment and diabetes optimisation with subsequent directly observed therapy at home. The patient, initially under-weight at presentation, gained 11Kg during the 6 week hospitalisation. Although exact mechanisms have not been identified, it is believed that hyperglycemia impacts an individual’s immune system leading to an immunocompromised state. This case highlights the immunosuppressive effect that persistent hyperglycemia has on a patient with diabetes mellitus leading to the development of pulmonary TB. Despite advancements in diabetes therapies, deprivation remains an important determinant of healthcare outcomes.