We read with interest the article by Suri et al. (1). In this article, we find a systematic review and meta-analysis of articles assessing diabetes during diarrhea-associated hemolytic uremic syndrome (D+HUS). The 21 included studies describe 49 children who developed diabetes during acute D+HUS. Long-term outcome was reported for 44 of 49 children: 13 of 34 survivors were left with persistent diabetes requiring insulin; 11 had persistent diabetes from the outset, while 2 redeveloped diabetes at 3 and 60 months after initial apparent recovery, respectively. The remaining 21 children were reported to have made a complete recovery from diabetes. However, follow-up was <12 months or not reported for these children.
We report a boy with relapse of diabetes after 82 months (6.8 years). This boy was hospitalized with severe D+HUS when he was 6 years old. During his stay in the intensive care unit, he developed hyperglycemia and was treated with insulin during 21 days. Eighty months later he presented with nose obstruction and headache and was diagnosed with sinusitis and polyposis nasi. He was treated with antibiotics, but the complaints persisted. Two months later, he was operated on (functional endoscopic sinus surgery), and postoperatively he received 2 mg betamethason for 5 days. On the 5th day, he presented in the emergency department with polyuria, polydipsia, and lethargy. His glycemia was 1,500 mg/dl, and his blood pH was 7.33. He was intravenously treated with insulin, and the corticosteroids were ceased.
To differentiate between type 1 diabetes, glucocorticoid-induced diabetes, and post-HUS diabetes, some additional blood tests were done. Pancreatic autoantibodies, including islet cell, insulin, GAD65, and insulinoma-associated protein 2 antibodies were all negative. Insulin was 4 mU/l for a glycemia of 1,453 mg/dl. After normalization of the glycemia, the boy was started on a basal-bolus regimen with insulin aspart and insulin glargine. Twenty months later, he still requires insulin (0.5 units · kg−1 · day−1) and has an HbA1c of 6.8%.
Our report in which we describe a relapse of diabetes after 82 months confirms the conclusion of Suri et al. that survivors of D+HUS should have aggressive surveillance and treatment of hyperglycemia, not only in the acute phase but also in the long run.
