RÉSUMÉ
Objetive: To analyze the hematological changes of systemic lupus erythematosus (SLE) and the clinical characteristics of immune-related hypoglycemia, and to provide the basis for the diagnosis and treatment of SLE complicated with autoimmune hypoglycemia (AIH). Methods: The clinical data a patient with SLE complicated with AIH with pancytopenia as the first manifestation were collected and the relevant literatures were reviewed. Results: A 70-year-old man was admitted to hospital because of dizziness and fatigue, and suffered from more than 3 months, aggravated for 2 weeks. The physical examination results showed pale conjunctiva, moist rales over the both lower lung and there were no other obvious positive signs. The blood test showed pancytopenia and the fasting blood glucose 2. 34 mmol · L-1 The pathomorphology of tissue was observed by bone marrow puncture; rheumatism examinations, glucose metabolism indexes, insulin autoantibodies (IAA) and other assistant examinations were performed, and the patient received the related treatment. The patient had a history of photosensitivity. Admission examinations indicated multiple serous effusions, urinary protein >). 5 g · 24 h-1, pancytopenia, abnormal antinuclear antibody (ANA) titer, pancreatic CT (-), and the patient was diagnosed as SLE complicated AIH finally. After treatment of prednisone, the symptoms of the patient were improved; the the whole blood count and fasting blood glucose responded well to the therapy of prednisone. After discharge from the hospital, the patient was treated with prednisone continuously and was required to regularly monitor the blood test and the blood glucose level. The patient's whole blood count was gradually increased and no hypoglycemia occurred. Conclusion: SLE with hematological changes as the first manifestation is easily misdiagnosed. And autoantibody-mediated glucose homeostasis should be considered when SLE is complicated with hypoglycemia.
RÉSUMÉ
Type B insulin resistance syndrome (TBIRS) is known as a rare autoimmune disease which usually presents with con-tinuous hyperglycemia under large amount of insulin. This article described and analyzed the medical treatment of an elderly patient with TBIRS participated by clinical pharmacists. In the whole process of treatment,clinical pharmacists helped physicians establish an individual treatment scheme according to the patient's basic situation,characteristics of blood glucose,pathophysiology and concomitant diseases. On the basis of proper anti-hyperglycemic scheme,clinical pharmacists suggested that the patient be treated with glucocorti-coids and immunoregulators,and then thorough pharmaceutical care was provided for the patient. Finally, the patient's insulin dose decreased and blood glucose was better than that before the admission,which indicated the effect of medical treatment and the value of clinical pharmacists.
RÉSUMÉ
Type B insulin resistance syndrome is rare autoimmune disease that is characterized by various abnormalities of glycemic homeostasis, from hyperglycemia caused by extreme insulin resistance to fasting hypoglycemia. It can combine with other autoimmune diseases, most commonly systemic lupus erythematosus. It usually occurs in women and accompanies acanthosis nigricans, hyperandrogenism, and, in many cases, ovary dysfunction. The diagnosis of type B insulin resistance syndrome is based largely on the presence of insulin receptor autoantibodies and hyperglycemia, or hypoglycemia and hyperinsulinemia. In some cases, patients with the type B insulin resistance have been successfully treated with immunosuppressive therapy and plasmapheresis. We experienced type B insulin resistance syndrome in a patient with chronic hepatitis B and used only plasmapheresis for treatment. The immunosuppressive therapy was omitted due to the state of activation of chronic hepatitis B. We present this case with a review of relevant literature.