Diabetes and immune thrombocytopenic purpura: a new association with good response to anti-CD20 therapy.

Type 1 diabetes (T1D) is rarely a component of primary immune dysregulation disorders. We report two cases in which T1D was associated with thrombocytopenia. The first patient, a 13-year-old boy, presented with immune thrombocytopenia (ITP), thyroiditis, and, 3 wk later, T1D. Because of severe thrombocytopenia resistant to immunoglobulins, high-dose steroids, and cyclosporine treatment, anti-cluster of differentiation (CD20) therapy was introduced, with consequent normalization of thrombocytes and weaning off of steroids. Three and 5 months after anti-CD20 therapy, levothyroxin and insulin therapy, respectively, were stopped. Ten months after stopping insulin treatment, normal C-peptide and hemoglobin A1c (HbA1c) levels and markedly reduced anti-glutamic acid decarboxylase (GAD) antibodies were measured. A second anti-CD20 trial for relapse of ITP was initiated 2 yr after the first trial. Anti-GAD antibody levels decreased again, but HbA1c stayed elevated and glucose monitoring showed elevated postprandial glycemia, demanding insulin therapy. To our knowledge, this is the first case in which insulin treatment could be interrupted for 28 months after anti-CD20 treatment. In patient two, thrombocytopenia followed a diagnosis of T1D 6 yr previously. Treatment with anti-CD20 led to normalization of thrombocytes, but no effect on T1D was observed. Concerning the origin of the boys' conditions, several primary immune dysregulation disorders were considered. Thrombocytopenia associated with T1D is unusual and could represent a new entity. The diabetes manifestation in patient one was probably triggered by corticosteroid treatment; regardless, anti-CD20 therapy appeared to be efficacious early in the course of T1D, but not long after the initial diagnosis of T1D, as shown for patient two.

Risk factors for under- and overweight in school children of a low income area in Kolkata, India.

BACKGROUND & AIMS: Socio-economic and individual lifestyle features associated with the nutritional state were examined in 7-9-year-old children of lower and lower middle-class families living under the international poverty line. Mild and moderate undernutrition was frequent but overweight also occurred. METHODS: Three groups of sex- and age-matched randomly selected children from the Kolkata Child Nutrition Study (data collection between April and November 2001) attending public primary schools of North Kolkata participated (42 children of low body mass index (BMI<12 kg/m(2),=LBMI), 100 children of intermediate BMI (14-16 kg/m(2); IBMI) and 51 children of high BMI (>16 kg/m(2); HBMI). Individual and social characteristics of the three BMI categories were assessed using a structured interview of their families. RESULTS: Families of LBMI children owned more TV (83.3% versus 60%; p-value: 0.007) and spent less money for rice (80.4% versus 52.5% of the families spent less than 11 Indian rupees (INR) for rice/day, p<0.003) when compared to families of IBMI children while income of the families of the 2 groups was similar. The families of HBMI children had more income per head per day (62.5% versus 32% earned more than 19 INR/head/day, p<0.02). CONCLUSIONS: Lifestyle and socio-economic differences in families are associated with distinct variations in body weight of their children in a population living in a low income area in Kolkata. Various degrees of poverty may lead to a propensity to develop both, underweight and modest overweight.