• Naoko Obi, Takuyuki Katabami, Shiko Asai, Nobuhiko Saito, and Yasushi Tanaka.
• Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki.
• Intern. Med. 2008 Jan 1; 47 (9): 847-51.

AbstractA 28-year-old woman with severe ketoacidosis was admitted to our hospital on day 11 after giving birth. However, her HbA(1C) level was normal (5.2%) and both GAD and anti-insulin autoantibody were negative, and the WBC count was extremely high (57,500/ml) with immature leucocytes in the peripheral blood. Her WBC count decreased along with control of ketoacidosis and reduction of the plasma glucose level, and was normalized on day 5 after admission. Bone marrow aspiration subsequently showed no malignant cells, so the final diagnosis was fulminant type 1 diabetes combined with a leukemoid reaction. This is the first report of a patient with both fulminant type 1 diabetes and a leukemoid reaction. The mechanism that triggered the leukemoid reaction could not be clarified, but severe ketoacidosis may have been involved.

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