082 – Combined Low carbohydrate Diet – Rituximab extended Honeymoon Period in a GAD positive Polyneuropathy -Type 1 Diabetes Mellitus patient case report

Electronic Poster | Session 2

082 – Combined Low carbohydrate Diet – Rituximab extended Honeymoon Period in a GAD positive Polyneuropathy -Type 1 Diabetes Mellitus patient case report

Wolfgang Trillo Alvarez (1) – Joshua Andree Medina Suarez (1) – Maria de Los Angeles Ibañez Mogrovejo (1) – Marineives Lizeth Mejia Vega (1) – Renato Alonso Caceres Amado (1) – Joaquin Jesus Molina Acosta (1) – Claudio Roberto Ibañez Escalante (1) – Jonatan David Escalante Ortiz (1) – Adriana Zaida Escalante Mercado (1) – Miguel Angel Manchego Bautista (1) – Juan Ignacio Santiago Valdivia Pino (1)
SINAPSIS, UCSM School of Medicine, Arequipa, Peru (1)


Objective: Report extended honeymoon period in a patient with Polyneuropathy – type 1A diabetes mellitus. Background: Type1 diabetes mellitus causes the destruction of pancreatic beta cells. Follicular helper T cells play an important role in the maturation and antibody production of beta cells. T follicular helper cells number is increased in type 1 diabetes mellitus, and their count correlates with fasting C peptide. Rituximab, a monoclonal antibodies against CD20, reduces Tfh cells number, IL6 and IL21 levels in peripheral blood. Rituximab has also proven to reduce the autoimmune destruction of beta cells by coupling to B cells and induce immune tolerance thus avoiding the progress of the immune reaction. Methods: a 15 years old latin male with past medical history of urine ketones at age 7, hyperglycemia up to 580 mg/dl was brought to the clinic with polyuria, polydipsia and headache. At physical was positive for signs of polyneuropathy with distal paresthesia, burning pain in palms and soles, Raynaud phenomenon, diminished tendon reflexes, and diminished sensation in four extremities. Laboratory results were relevant for basal glucose: 285.3 mg/dl, HbA1c: 9, anti GAD65: positive, EMG: positive for sensory motor axonal neuropathy. Polyneuropathy – Type 1 diabetes Mellitus diagnosis was stablished. Results: Treatment with an intensive low carbohydrate diet, with Rituximab 1 grm Q/15 days and 1 grm Q/6 months, IV pulse methylprednisolone, hydroxychloroquine 200mg Q/day and Azathioprine 50mgQ/day was started. After treatment anti GAD antibodies became negative and have stayed negative for 65 weeks since, HbA1c is 5.9 and symptoms of polyneuropathy resolved including normal tendon reflexes. Conclusion: Transitory depletion of B-lymphocytes with Rituximab lowers B cell mediated beta cell lysis in patients with type 1 diabetes mellitus. In human essays one can predict that monoclonal antibodies against CD20, anti CD22, and anti T cell antibodies would be most efficacious in newly diagnosed type 1 diabetes or during the Honeymoon period. We report a case of a 15 years old latin male with stablished type 1A diabetes and polyneuropathy that reached 65 weeks extended Honeymoon Period with a combined diet and anti CD20 antibody treatment.