New Onset Type-1 Diabetes Mellitus in a Toddler with Sars-Cov-2 Infection Presenting In Diabetic Ketoacidosis: A Case Report

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), though mostly sparing the lungs in children, has been found to affect other organs including the endocrine pancreas. Type 1 diabetes mellitus (T1DM) may occur through direct negative effects of the virus on beta-cell function leading to diminished insulin production. Diabetic ketoacidosis (DKA) is a known and life-threatening complication of T1DM. Case presentation: This is a case of a 3-year-old previously healthy male who presented with 4 days history of fever, with malaise and hyperpnea for one day. Review of systems was notable for increased thirst and urination, nausea, vomiting, fatigue, and visible weight loss for 4 days. Initial investigations done showed elevated blood glucose, ketonuria, increased anion gap metabolic acidosis, and positive SARS-CoV-2 polymerase chain reaction (PCR). He was immediately commenced on intravenous fluids and insulin with progressive improvement and was discharged on hospital day 6. Conclusion: Coronavirus disease-2019 (COVID-19) has impacted children most profoundly with the new post-infectious multi-inflammatory syndrome, however, it is important to remember that primary coronavirus infection is still a threat to pediatric patients, for example, and its cytotoxic effects on the pancreatic beta cells that may lead to T1DM. We, therefore, recommend that caregivers, parents, and medical professionals should have a high index of suspicion when children present with symptoms consistent with a diagnosis of T1DM during the COVID-19 pandemic so that diagnosis can be made promptly and therefore DKA prevented.