An Eighty-three-year-old woman diagnosed with slowly progressive insulin-dependent (type 1) diabetes mellitus due to high serum level of anti-glutamic acid decarboxylase antibody underwent coronary artery bypass grafting. She had abdominal pain and died 5 days after the operation. At autopsy, we found dissection of the right coronary artery, acute myocardial ischemia at the posterior septal wall, and severe necrosis from the duodenum to the ascending colon. In the pancreas, several islets showed large, deformed, and diminishing insulin- and glucagon-positive cells. The β-cell mass was reduced. We found infiltration of cluster of differentiation 8-positive lymphocytes in the acinar cells and islets. Sustained anti-glutamic acid decarboxylase antibody positivity in the present patient might be associated with the prolonged oxidative and proinflammatory states and the subsequent induction of myocardial and mesenteric ischemia.
Yoko Matsuda, Atsushi Araki, Yasuhito Sakano, Yuko Chiba, Yusuke Tsuboko, Takashi Nishimura, Tomio Arai
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