Immunoadsorption Followed By Rituximab As A Definitive Treatment For Insulin Autoimmune Syndrome (Hirata Syndrome): A Case Report

A 59-year-old Caucasian man (170 cm, 78 kg, BMI 27 kg/m2) was referred for evaluation of recurrent episodes of severe hypoglycemia, which had commenced a week earlier. Computed tomography and MRI scans excluding abnormalities of the pancreas had already been performed. The patient had previously suffered from arterial hypertension, hyperlipoproteinemia, and an acute myocardial infarction the year before. Pharmacological therapy consisted of a β-receptor antagonist, a statin, low dose aspirin, clopidogrel, and vitamin D. Importantly, there was no history of alcohol abuse or diabetes and no previous exposure to antidiabetes medication (Fig. 1). Upon admission, the patient showed a sustained need for intravenous glucose supplementation with repetitive symptomatic declines of blood glucose to levels of relevant hypoglycemia (u003c2.5 mmol/L) immediately after discontinuation of parenteral glucose.Figure 1 Serum parameters in relation to the course of treatment. Results of IAB, protein, and IgG are depicted in the graph during the …