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Highly elevated tyrosine phosphatase antibodies in a type 1 diabetic patient with advanced diabetic complications and exocrine pancreatic dysfunction

Objective and Importance: Pancreatic exocrine insufficiency (PEI) is a phenomenon obsereved in type 1 diabetic mellitus (T1DM) patients interpreted as a disease complication and exaplained by several hypothesis. Impairment of enteropancreatic reflex and changes in gastrointestinal peptides due to diabetic autonomic neuropathy (DAN) is one of them. Autoimmune damage is speculated as one of the underlying cause in the DAN pathogenesis. Recent studies report that high levels of tyrosine phosphatase antibodies (IA-2Abs) may predict rapid pancreatic β cell faliure and could be indicative for more agressive autoimmunity. Case Presentation: A 55-year old T1DM male patient with 13 years diabetes duration presented with the symptoms of tingling and spasms in the hands and legs and every day diarrhea followed by meals. Several times he has been hospitalized at the Department of Gastroenterology due to diarrhea. No bacteriological or viral causes were found. Intervention: Neurological examination has showed severe case of DAN. Fecal fat test as well as muscule fiber presence in stool were positive. Immunology tests for T1DM specific antibodies revealed highly positive IA-2Ab (2128.0 IU/mL), low glutamic acid antibody titre (12, 9 IU/mL) and negative islet cell antibody titre (<5 JDF U). Following the metoclopramide three times 10 mg per os and pancreatin three times 400 mg per os daily, the patient started to recover and was subsequently discharged. Conclusion: We concider high IA-2Ab levels are involved in the pancreatic and autonomic nerve tissue damage either simultaneously or predominantly on one of them which concequently lead to the development of the another.

type 1 diabetes mellitus ; autoantibodies ; pancreatic exocrine insufficiency ; diabetic polyneuropathy

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