626 - Management of ITP altering the course of a newly diagnosed T1DM

Poster Number: 626
Publication Number: 626.3195

Background: T1D is associated with risk of other autoimmune conditions. Co-occurrence of T1D and ITP is rare and presented a unique challenge in management. The standard initial treatment of ITP is Intravenous Immunoglobulin [IVIG} and/or steroids. However, both may cause hyperglycemia, complicating management in a patient with T1D. Our patient received IVIG only and went into a euglycemic state of diabetes remission.

Objective: We present a case report of a 9 yo boy who was concurrently diagnosed with ITP and type 1 diabetes. Treatment of ITP impacted the course of his T1D significantly.

Design/Methods: A 9 yo boy presented with several days of unexplained bruising and mucosal bleeding, no history of trauma, bleeding disorders, or other systemic symptoms. Physical exam showed generalized petechiae, ecchymosis and purpura. Normal weight and BMI. Initial labs showed Platelets < 1000 microL with otherwise normal CBC and peripheral smear. A diagnosis of ITP was made. He was also noted to have hyperglycemia [260mg/dl] with glycosuria and trace ketonuria. Hemoglobin A1c was 10.5%, His insulin autoantibodies came back strongly positive confirming T1D. Other autoimmune disorders such as adrenal insufficiency, thyroid disease, celiac disease were ruled out.
Subsequently, the patient received 1 dose of IVIG 1g/kg and responded well, as his platelets improved to 6000 microL. Patient continued to have fasting hyperglycemia and was started on basal/bolus insulin regimen. By 2nd day post IVG patient had hypoglycemia and insulin was discontinued.

Results: The patient is now 5 months post IVIG. ITP has resolved, and he remains on a continuous glucose monitor, off insulin, on a regular diet, with avoidance of simple carbohydrates only. He remains euglycemic overnight with transient self-resolving post prandial hyperglycemia. His insulin autoantibodies remain strongly positive.

Conclusion(s): In patients with new T1D, IVIG may help to reduce insulin requirements/need for insulin therapy as seen in our patient. We hypothesize that treatment of ITP with IVIG has induced a state of remission for his T1D. IVIG is not a standard of treatment for T1D, however when given for other FDA approved indications it may alleviate the need for insulin in new and early diagnosed diabetics.