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A Case of Autoimmune Hypoglycemia in a Newly Diagnosed HIV Patient

새롭게 진단된 HIV 감염 환자에서 보고된 자가면역성 저혈당 1예

  • Lee, Hye-Won (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Baek, Dong-Hoon (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Kyung-Nam (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Cho, Eun-Jung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Sang-Soo (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Bo-Hyun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, In-Joo (Department of Internal Medicine, Pusan National University School of Medicine)
  • 이혜원 (부산대학교 의학전문대학원 내과학교실) ;
  • 백동훈 (부산대학교 의학전문대학원 내과학교실) ;
  • 이경남 (부산대학교 의학전문대학원 내과학교실) ;
  • 조은정 (부산대학교 의학전문대학원 내과학교실) ;
  • 김상수 (부산대학교 의학전문대학원 내과학교실) ;
  • 김보현 (부산대학교 의학전문대학원 내과학교실) ;
  • 김인주 (부산대학교 의학전문대학원 내과학교실)
  • Published : 2012.07.01

Abstract

Autoimmune hypoglycemia is a rare cause of hypoglycemia, characterized by insulin autoantibodies, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This paper reports autoimmune hypoglycemia in a patient with a newly diagnosed HIV infection. A 63-year-old female visited the emergency room because of decreased mentality with a low blood glucose and high plasma insulin concentration. There was no evidence of insulinoma and the anti-insulin antibody was positive at 92.42%, so she was diagnosed with autoimmune hypoglycemia. She also had positive human immunodeficiency virus (HIV) antibody tests, and the CD4-positive T cell count was 28/${\mu}$L. Therefore, a diagnosis of acquired immunodeficiency syndrome (AIDS) was confirmed and she was started on highly active antiretroviral therapy (HAART). The prednisolone therapy for the autoimmune hypoglycemia was held. Subsequently, she has maintained a stable plasma glucose level without dextrose. The recovery from hypoglycemia may reflect the diease course of the autoimmune hypoglycemia, or be the effect of a protease inhibitor.

인슐린 항체에 의한 자가면역성 저혈당의 기전에 대해서는 뚜렷한 결론은 없지만, 항인슐린 항체와 인슐린의 결합과 분리의 부조화로 나타난다고 보고되고 있으며, 여러 약제 및 자가면역 질환들과 동반되는 경우가 많다. HAART의 개발로 HIV 환자군의 생존률이 크게 향상되면서 HIV 감염 및 후 천성 면역 결핍 증후군과 자가면역질환의 발생이 관련이 있다는 보고가 증가하고 있으며, protease inhibitor를 복용한 환자군에서 당 불내성 등의 대사 장애가 나타나는 것으로 알려져 있다. 저자들은 내인성 고인슐린혈증을 동반한 저혈당 환자의 평가과정에서 후천성 면역 결핍증후군에 병발한 자가면역성 저혈당을 진단하였고, 후천성 면역 결핍증후군의 치료 과정 중 자가면역성 저혈당의 임상적 소견이 호전됨을 보였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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