Macrophage Activation Syndrome During Diabetic Ketoacidosis in A 9-Year-Old Girl: A Case Report

Background: Diabetic ketoacidosis (DKA) is a serious and common presentation of type 1 diabetes in children, often life-threatening without prompt management. Macrophage Activation Syndrome (MAS), a rare but severe hyperinflammatory condition, is exceptionally uncommon during DKA episodes. Case Presentation: We report the case of a 9-year-old girl with type 1 diabetes who presented with her sixth DKA episode due to poor treatment adherence. Initial assessment revealed dehydration, altered consciousness, pleural effusion, generalized edema, and abdominal distension. Laboratory tests showed bicytopenia, hepatic dysfunction, elevated triglycerides, and renal impairment—features suggestive of MAS. Despite the absence of hyperferritinemia and hypofibrinogenemia due to technical limitations, the clinical picture met the diagnostic criteria for MAS. The patient improved with intravenous insulin therapy but relapsed shortly after discharge due to treatment interruption. Conclusion: This case underlines the importance of considering MAS in children with DKA and multisystem involvement. Early recognition and multidisciplinary care are vital to prevent severe outcomes.