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Systemic lupus erythematosus and diabetic mellitus is it single or two entity(es)

  • Ni Made Mindawati ,
  • Ketut Dewi Kumara Wati ,
  • I Made Arimbawa ,
  • Ida Bagus Ramajaya Sutawan ,
  • I Made Darma Yuda ,

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a complex and chronic autoimmune disease with varied clinical manifestations and multi-organ involvement. The disease may present with acute, severe, and life-threatening symptoms or present as a fluctuating and chronic process that impacts several systems and increases the risk of malignancy. Systemic lupus erythematosus (SLE) often coexists with other diseases. Diabetes mellitus (DM) is an example and patients with SLE-DM can present with clinical features common to both disorders. Type 2 diabetes (T2D) is characterized by insulin resistance the inability of tissues to respond to insulin, and a progressive pancreatic beta cell dysfunction in response to glucose levels. The disease is thought to be caused by environmental and inherited factors in about equal proportions. Many environmental risk factors are known, including obesity, sedentary lifestyle, stress, nutritional factors and toxins. The report aims to describe Systemic Lupus Erythematosus and Diabetes mellitus as single or two entity(es).

Case presentation: A 14-year-old female patient who was admitted to the hospital with complaints of weakness and drowsiness was getting worse 3 days before admitted from hospital. There have been complaints of fatigue for last 3 years accompanied by a lot of eating and drinking and urinating. Complaints of pain in both joints of the hands and both knees appeared in the last 3 months and had been getting worse. Hair loss existed in the past 4 months before being admitted to the hospital. Blurred vision in the right eye in the last 6 months has worsened in the last 1 month. Vision loss in the last 3 months. Body weight was reduced 4 kilograms within 3 months without any loss of appetite. Initial laboratory results revealed hyperglycemia, antinuclear antibodies (ANA) IF 1:100 and ANA Profile Sm (+), dyslipidemia, increase of creatinine serum with glomerular filtration rate 72.41 m2/BSA (decreased 38%). Other examinations showed that C-peptide is normal and beta islet antibody is negative. Echocardiography resulted tricuspid regurgitation with normal ventricle function.

Conclusion: Systemic Lupus Erythematosus and Diabetes mellitus is a rare condition that warrants a thorough evaluation to both determine the diagnosis and predict the clinical course of disease.

References

  1. Twilt M, Feldman BM. An update in the diagnosis and management of juvenile dermatomyositis. Int. J. Rheumatol.2021;7(3):1-7.
  2. Hemminki K, Liu X, Försti A, Sundquist J, Sundquist K, Ji J. Subsequent Type 2 Diabetes in Patients with Autoimmune Disease. Sci Rep. 2015;5:13871.
  3. Rebecca ES, Stacy PA, and Laura ES. Systemic Lupus Erythematosus. In: Kliegman RM, Bonita FS, Joseph WS, Nina FS, editor. Nelson Textbook of Pediatrics. 20nd ed. Philadelphia: Elsevier; 2016. h.1176-80.
  4. Abari IS. ACR/SLICC revised criteria for diagnosis of systemic lupus erythematosus. Autoimmune Dis Ther Approaches. 2015;2:1-5.
  5. Wu JQ, Lu MP, Reed AM. Juvenile dermatomyositis: advances in clinical presentation, myositis-specific antibodies and treatment. World J Pediatr. 2020;16:31-43.
  6. Cortes S, Chambers S, Jerónimo A, Isenberg D. Diabetes mellitus complicating systemic lupus erythematosus - analysis of the UCL lupus cohort and review of the literature. Lupus. 2008.Nov;17(11):977-80.
  7. Doria A, Iaccarino L, Sarzi-Puttini P, Atzeni F, Turriel M, Petri M. Cardiac involvement in systemic lupus erythematosus. Lupus. 2005;14:583-6.
  8. Chan JC, Knight AM, Xiao R, Mercer-Rosa LM, Weiss PF. Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus. Lupus. 2018;27(8):1348-57.
  9. Dayal Na, Isenberg DA. SLE/myositis overlap: are the manifestations of SLE different in overlap disease? Lupus. 2002;11:293-8.
  10. Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1-58.
  11. Gottlieb BS. Systemic Lupus Erythematosus in Children and Adolescents. Pediatric in Review. Pubmed. 2021;27(9):323-30.
  12. Lin YJ, Chien CC, Ho CH, Chen HA, Chen CY. Increased risk of type 2 diabetes in patients with systemic lupus erythematosus: A nationwide cohort study in Taiwan. Medicine (Baltimore). 2022 Dec 23;101(51):e32520.
  13. El Magadmi M, Ahmad Y, Turkie W, et al.. Hyperinsulinemia, insulin resistance, and circulating oxidized low density lipoprotein in women with systemic lupus erythematosus. J Rheumatol. 2006;33:50–6.
  14. Sánchez PH, Tejera SB, de Vera GA, et al.. Insulin resistance in systemic lupus erythematosus patients: contributing factors and relationship with subclinical atherosclerosis. Clin Exp Rheumatol. 2017;35:885–92.
  15. Suh S, Park MK. Glucocorticoid-induced diabetes mellitus: an important but overlooked problem. Endocrinol Metab (Seoul). 2017;32:180–9.
  16. Wu J, Mackie SL, Pujades RM. Glucocorticoid dose-dependent risk of type 2 diabetes in six immune-mediated inflammatory diseases: a population-based cohort analysis. BMJ Open Diabetes Res Care. 2020;8:e001220.
  17. Leighton E, Sainsbury CAR, Jones GCA. Practical Review of Peptide Testing in Diabetes. Diabetes Therapy J. 2017;8:475-87.
  18. Putranto TA, Wibisono D, Astoro NW, Yana ML, Prabowo ET, Irwansyah D, Nurhadiyanta N, Rantung Y, Ikrar T, Fandrich F. Introducing the tolerogenic macrophage therapy as an alternative approach to manage systemic lupus erythematosus: a case series. Bali Med J. 2019;8(3):726-32.

How to Cite

Mindawati, N. M. ., Wati, K. D. K. ., Arimbawa, I. M. ., Sutawan, I. B. R. ., & Yuda, I. M. D. . (2023). Systemic lupus erythematosus and diabetic mellitus is it single or two entity(es). Intisari Sains Medis, 14(3), 1146–1151. https://doi.org/10.15562/ism.v14i3.1876

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Ni Made Mindawati
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Ketut Dewi Kumara Wati
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I Made Arimbawa
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Ida Bagus Ramajaya Sutawan
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I Made Darma Yuda
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