Antineutrophil cytoplasmic antibody-associated neutropenia in a patient with type 1 diabetes mellitus.

Abstract

Case report: Our case is a 37-year old male, who admitted to hospital several times with infections accompanying neutropenia. On his last admission, he had fever, chills, abdominal pain, nausea, vomiting and diarrhea. He had been treated with an insulin regimen for six years, but HbA1C level was 8.4%. Further investigation revealed high CRP (23 mg/L) and ESR (30 mm/h), positive RF (16.7; normal range 0-15) and C-ANCA levels. Whole body CT scan failed to identify a lesion and he received 15-day tazobactam antibiotherapy. Filgrastim (G-CSF) was given, but neutrophil counts did not respond and we switched to steroid therapy. Symptoms got better, neutrophil counts rised gradually and antibiotherapy was stopped. Due to the potential side effects of steroids and abnormal blood sugar levels, we started intravenous immunoglobulin (IVIG) therapy (400mg/kg/day-monthly) with moderate doses of prednisolone.