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Case Reports
. 2023 Aug;14(8):1005-1008.
doi: 10.1111/jdi.14020. Epub 2023 Jun 15.

A case of fulminant type 1 diabetes and protein C deficiency complicated by deep vein thrombosis

Masato Kohata  1 , Shinjiro Kodama  1 , Nobuhiro Yaoita  2 , Shinichiro Hosaka  1 , Kei Takahashi  1 , Keizo Kaneko  1 , Junta Imai  1 , Satoshi Yasuda  2 , Hideki Katagiri  1
Affiliations
Case Reports

A case of fulminant type 1 diabetes and protein C deficiency complicated by deep vein thrombosis

Masato Kohata et al. J Diabetes Investig. 2023 Aug.

Abstract

A 25-year-old man was diagnosed with diabetic ketoacidosis (DKA) at the onset of fulminant type 1 diabetes. After acute-phase DKA treatment including placement of a central venous catheter, a massive deep vein thrombosis (DVT) and pulmonary embolism (PE) were detected on hospital day 15. His protein C (PC) activity and antigen levels were low even 33 days after completing the DKA treatment, indicating partial type I PC deficiency. Severe PC dysfunction, due to overlapping of partial PC deficiency and hyperglycemia-induced PC suppression, concomitant with dehydration and catheter treatment, may have induced the massive DVT with PE. This case suggests that anti-coagulation therapy should be combined with acute-phase DKA treatment in patients with PC deficiency, even those who have been asymptomatic. As patients with partial PC deficiency should perhaps be included among those with severe DVT complications of DKA, venous thrombosis should always be considered as a potential complication of DKA.

Keywords: Deep vein thrombosis; Diabetic ketoacidosis; Protein C.

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Conflict of interest statement

The authors declare no conflict of interest.

Approval of the research protocol: N/A.

Informed consent: The patient provided written informed consent of this case report.

Registry and the registration no. of the study/trial: September 20, 2022, No. 27404.

Animal studies: N/A.

Figures

Figure 1
Figure 1
Contrast‐enhanced computed tomography images obtained on days 15 and 31. Yellow arrows indicate the thrombus.
See this image and copyright information in PMC

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References

    1. Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the research of fulminant and acute‐onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). J Diabetes Investig 2012; 3: 536–539. - PMC - PubMed
    1. Gutierrez JA, Bagatell R, Samson MP, et al. Femoral central venous catheter‐associated deep venous thrombosis in children with diabetic ketoacidosis. Crit Care Med 2003; 31: 80–83. - PubMed
    1. Scordi‐Bello I, Kirsch D, Hammers J. Fatal pulmonary thromboembolism in patients with diabetic ketoacidosis: a seven‐case series and review of the literature. Acad Forensic Pathol 2016; 6: 198–205. - PMC - PubMed
    1. Ceriello A, Quatraro A, Dello Russo P, et al. Protein C deficiency in insulin‐dependent diabetes: a hyperglycemia‐related phenomenon. Thromb Haemost 1990; 64: 104–107. - PubMed
    1. Carl GF, Hoffman WH, Passmore GG, et al. Diabetic ketoacidosis promotes a prothrombotic state. Endocr Res 2003; 29: 73–82. - PubMed

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