Lung abscess without sepsis in a patient with diabetes with refractory episodes of spontaneous hypoglycemia: a case report and review of the literature.
Lung abscess without sepsis in a patient with diabetes with refractory episodes of spontaneous hypoglycemia: a case report and review of the literature.
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DOI：
10.1186/1752-1947-8-51
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发表时间：
2014-02-13
影响因子：
1
通讯作者：
Kadowaki T
中科院分区：
文献类型：
--
作者：
Toda G;Fujishiro M;Yamada T;Shojima N;Sakoda H;Suzuki R;Yamauchi T;Ueki K;Kadowaki T
低血糖是相当多的发病率的原因。虽然在感染性休克的情况下有低血糖的记录，并且与较高的死亡率相关，但文献中尚未报告无脓毒症的感染性低血糖。一名72岁的日本女性，接受大剂量糖皮质激素治疗自身免疫性溶血性贫血，以及强化胰岛素治疗2型糖尿病，出现严重低血糖。通过影像学检查诊断为肺脓肿，并静脉注射抗生素治疗。尽管适当降低了降糖治疗，但肺脓肿加重期间低血糖自发复发。在肺脓肿得到控制后，仅发生轻度零星低血糖发作。感染伴营养不良和免疫抑制，尽管没有败血症，但可能导致低血糖。在管理患有本文所述疾病（即营养不良和免疫抑制）的糖尿病患者的低血糖时应谨慎，因为感染可能是一个促成因素。
Hypoglycemia is a cause of considerable morbidity. Although hypoglycemia has been documented in the setting of septic shock and has been associated with higher mortality, hypoglycemia in infection without sepsis has not been reported in the literature. A 72-year-old Japanese woman treated with high-dose glucocorticoids for autoimmune hemolytic anemia, as well as intensive insulin therapy for type 2 diabetes, presented with severe hypoglycemia. A lung abscess was diagnosed by imaging studies and treated with intravenous antibiotics. Hypoglycemia spontaneously recurred during lung abscess exacerbations, despite appropriate de-escalation of antidiabetic therapy. Only mild sporadic episodes of hypoglycemia occurred after the lung abscess was controlled. Infection accompanied with malnutrition and immunosuppression, although in the absence of sepsis, may have contributed to hypoglycemia. Caution is warranted in the management of hypoglycemia in patients with diabetes with the conditions described here, that is malnutrition and immunosuppression, as infection may be a contributing factor.