Type B insulin resistance syndrome induced by systemic lupus erythematosus and successfully treated with intravenous imm
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ORIGINAL ARTICLE
Type B insulin resistance syndrome induced by systemic lupus erythematosus and successfully treated with intravenous immunoglobulin: case report and systematic review Sigong Zhang & Guochun Wang & Jinping Wang
Received: 23 July 2012 / Revised: 16 September 2012 / Accepted: 21 September 2012 / Published online: 3 October 2012 # Clinical Rheumatology 2012
Abstract Type B insulin resistance syndrome is characterized by the formation of autoantibodies against insulin receptors, which can cause severe hyperglycemia and insulin resistance. Systemic lupus erythematosus is the most common underlying diseases of the syndrome. This report details our study of a case involving a Chinese female with type B insulin resistance syndrome as well as systemic lupus erythematosus who completely recovered after undergoing immunosuppressive therapy, specifically pulse therapy utilizing intravenous immunoglobulin. We also conducted search in MEDLINE and Chinese BioMedicine database to identify relevant literatures published in the past 46 years. From our searches, six case reports in Chinese, 15 case reports, and a 28-year perspective article in English met our criteria; a total of 67 cases were included in our report. The mean age of subjects at presentation for groups A, B, and C were 42.95, 44.10, and 41.68 years, respectively, yielding no significant difference between these groups. African Americans were the most susceptible group to type B insulin resistance syndrome, followed by Asians representing 20.90 % of all cases. Comparisons between the three main racial groups surveyed indicated that the mean age of subjects at presentation were very contiguous for African Americans and Asians, and mean age of white people was remarkably higher than either of the first two groups. The syndrome appeared most common among Asian males, and white males were relatively less likely to suffer from type B S. Zhang : G. Wang (*) Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing 100029, People’s Republic of China e-mail: [email protected] J. Wang Department of Rheumatology, Gansu Provincial Hospital, 204 Dong Gang Xi Lu, Lanzhou, Gansu 730000, People’s Republic of China
insulin resistance syndrome. Hypoglycemia was most commonly observed in white people than in other racial groups. Hypoalbuminemia, elevated serum immunoglobulin G, and elevated sedimentation rates were more common in African Americans; Asian cases were more likely to show low serum C3 or C4 and nephritis. Two cases received intravenous immunoglobulin therapy, which has a remarkably rapid effect on insulin resistance. Keywords Autoimmune disease . Intravenous immunoglobulin . Systemic lupus erythematosus . Type B insulin resistance syndrome
Introduction Type B insulin resistance syndrome is an autoimmune phenomenon caused by polyclonal immunoglobulin G antibodies that exhibit antagonist activity directed against insulin receptors. A series of autoimmune diseases can induce these autoantibodies and ca
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