A Case of Diabetes Mellitus Treated with Glucocorticoids

A 55-year-oldman presented to his general practitioner (GP) with a 3-week history of flu-like symptoms, pruritis, weight loss, and diarrhea. Initial investigations showed eosinophilia, 32.2 10/L (normal range: 0 to 0.5 10/L) and a normal random glucose. He was seen in a general medical clinic 3 weeks after the initial referral from GP and, at this point, had polyuria and polydipsia. He was previously well and was on no medication. He is a nonsmoker, drinks alcohol occasionally, and denies illicit drug abuse. There had been no recent travel abroad. Physical examination was unremarkable. Repeat investigations showed ongoing eosinophilia (33.5 10/L), elevated randomblood glucose (15.9mmol/L), raised hemoglobin A1c (HbA1c) (89mmol/mol, i.e., 10.3%), raised creatinine (171 μmol/L; 1.93mg/dL), and normal liver function tests. There were no ova, cysts, or parasites in urine or stool. Strongyloides, hepatitis, and human immunodeficiency virus serology were negative, as were the antinuclear antibody and antineutrophil cytoplasmic autoantibody. A cytogenetic analysis test and F1P1L1-PDGFRA (to rule out eosinophilic leukemia) were also negative. Renal function normalized with intravenous fluid support. Acute kidney injury was thought to be secondary to diarrhea and osmotic diuresis. Computed tomography (CT) scan of the chest and abdomen showed a generally swollen and bulky pancreas (►Fig. 1). Management and Progress