Here we report a case where the manifestations of insulin-dependent diabetes occurred following SARS-CoV-2 infection in a young individual in the absence of autoantibodies typical for type 1 diabetes mellitus. Specifically, a 19-year-old white male presented at our emergency department with diabetic ketoacidosis, C-peptide level of 0.62 µg l^–1, blood glucose concentration of 30.6 mmol l^–1 (552 mg dl^–1) and haemoglobin A1c of 16.8%. The patient´s case history revealed probable COVID-19 infection 5–7 weeks before admission, based on a positive test for antibodies against SARS-CoV-2 proteins as determined by enzyme-linked immunosorbent assay. Interestingly, the patient carried a human leukocyte antigen genotype (HLA DR1-DR3-DQ2) considered to provide only a slightly elevated risk of developing autoimmune type 1 diabetes mellitus. However, as noted, no serum autoantibodies were observed against islet cells, glutamic acid decarboxylase, tyrosine phosphatase, insulin and zinc-transporter 8. Although our report cannot fully establish causality between COVID-19 and the development of diabetes in this patient, considering that SARS-CoV-2 entry receptors, including angiotensin-converting enzyme 2, are expressed on pancreatic β-cells and, given the circumstances of this case, we suggest that SARS-CoV-2 infection, or COVID-19, might negatively affect pancreatic function, perhaps through direct cytolytic effects of the virus on β-cells.

在这里，我们报告了一种病例，其中在年轻患者中出现SARS-CoV-2感染后出现胰岛素依赖型糖尿病的表现，而该患者缺乏典型的1型糖尿病自身抗体。具体来说，一名19岁的白人男性在我们的急诊科就诊，患有糖尿病性酮症酸中毒，C肽水平为0.62 µg l ^–1，血糖浓度为30.6 mmol l ^–1（552 mg dl ^–1）和血红蛋白A1c为16.8％。患者的病史显示，入院前5-7周可能是COVID-19感染，这是通过酶联免疫吸附测定法确定的针对SARS-CoV-2蛋白的抗体阳性试验得出的。有趣的是，患者携带的人类白细胞抗原基因型（HLA DR1-DR3-DQ2）被认为只会增加自身免疫性1型糖尿病的风险。但是，如上所述，没有观察到针对胰岛细胞，谷氨酸脱羧酶，酪氨酸磷酸酶，胰岛素和锌转运蛋白8的血清自身抗体。尽管我们的报告不能完全确定COVID-19与该患者糖尿病的发生之间的因果关系，考虑到SARS-CoV-2进入受体（包括血管紧张素转化酶2）在胰腺β细胞上表达，