What skin diseases affect people of color
The special caseBlack skin, dramatic weight loss
Bonn, a mild early summer day. As every morning, Saliha Pejić prepares for her working day. Lost in thought, the Serb looks in the mirror - and freezes with shock.
"It started four years ago when the skin on my face suddenly turned almost black and within the next three months I lost an additional 30 kilograms. I then went to the doctor who first drew my blood. Then you have it found that I have diabetes, I had a sugar level of 450. Because my family doctor didn't know what to do with these symptoms, he referred me to a hospital. "
Healthy sugar levels are between 70 and 100
In healthy people, the sugar value fluctuates between 70 and 100 milligrams per deciliter of blood; if the value is over 200 milligrams, doctors diagnose diabetes mellitus. The dramatic accompanying symptoms can be a consequence of the diabest, but do not have to be.
"A severe weight loss is initially suspected of a malignant disease, that is cancer, and the blackness of the skin, that is the melanocytes that cause the skin's coloration, and they have obviously been stimulated in certain places, especially in the neck, because it has started on the stressed areas of skin over the joints, on the wrinkles on the face, and that was extremely pronounced. "
Privatdozent Dr. Lars Möller, Senior Physician at the Clinic for Endocrinology and Metabolic Diseases at the University Hospital Essen.
"My doctor then referred me to a hospital, where I was inpatient for seven weeks. They did all sorts of tests and examinations, but the doctors in the clinic couldn't find the cause of these symptoms either. I was then discharged without a diagnosis been. "
"Now comes the difficulty! The weight loss actually goes with an insulin deficiency diabetes, a type 1 diabetes. What Ms. Pejić had, however, were high insulin levels, which would rather speak for an insulin resistance, a type 2 diabetes, which includes weight gain and being overweight, not losing weight, so two things that don't go together, but the sugar that was there. "
Measures have no effect
"The clinic, which was unable to make a diagnosis, then referred me to a doctor's practice specializing in diabetes. There I was again thoroughly examined, I was given plans of what I was allowed to eat and what not, how much insulin I had to inject and when I even got an insulin pump that was plugged into my stomach. I did all of that, but unfortunately it didn't help. "
"Ms. Pejić lost weight because the insulin didn't work, because insulin actually ensures that the sugar gets into the cells, and because that didn't work for Ms. Pejić, no sugar could get into the cells and they practically starved to death, if you want to say it vividly, and because of that Ms. Pejic lost weight. "
Blood sugar has now reached extreme values of almost 1,000 milligrams per deciliter of blood. A third medic is called in.
"The third specialist also read all previous test results again, the blood values were determined, but he was quick of the opinion that this could not be normal diabetes, he suspected a hidden tumor. Because he had not found it, I followed Essen was referred to the University Hospital. The first thing they did there was to remove the insulin pump. "
It is useless, according to Lars Möller, because there is enough insulin, but for some reason the vital hormone does not work on the cells and the sugar therefore does not get into the cells.
“As an explanation, we then considered that an antibody against the insulin receptor could be the cause. That would explain why she produces a lot of insulin herself, but it cannot work because an antibody blocks the receptor Bodies are formed as a defense against bacteria, viruses, which sometimes also recognize the body's own structures as an autoimmune disease. "
Testing for antibodies
An elegant explanation, but can it be proven? Möller sends blood samples to a special laboratory to look for antibodies.
"And it came back a negative result! The statement was that there are no antibodies against the insulin receptor. Then we were actually back to zero!"
A shock, especially since Saliha Pejić‘s condition is now life-threatening. Lars Möller still has a tiny glimmer of hope. Maybe the measurement method was inaccurate ?!
"We looked to see who can still measure that and then came across a laboratory in Cambridge, England, which is scientifically researching these antibodies against the insulin receptor, and asked whether they would examine Ms. Pejić's blood to see if the antibody was present. "
They examined it - and they actually found antibodies! Finally, the Bonn woman can be treated in a targeted manner.
"We tried two different things, first we gave immunoglobulins in the imagination that they could intercept these incorrectly produced antibodies, and tried plasmapheresis, a kind of dialysis procedure in which the plasma is exchanged to remove the antibodies from their blood get out. "
Last second rescue
Another setback! None of the measures work! The sugar level remains unchanged high! Doctors in Essen are feverishly looking for other treatment strategies. Since the antibodies cannot be eliminated directly, they want to target the cells that produce the antibodies. You find a drug called "Rituximab", ...
"... that is directed against the B cells, that is, against the cells that produce the antibodies."
Lars Möller administered "Rituximab" twice in combination with two other drugs. Hardly anyone would have thought what would happen next. Saliha Pejić's condition normalized within four months. The sugar level drops, the weight increases.
"I was so happy that the cause of my illness had finally been found. I am deeply grateful to the doctors, in the end I thought either they would find the cause or I would die. Actually, a new life has begun for me Has!"
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