Long‐term remission of type B insulin resistance syndrome with immunotherapy: A case report

We report long-term remission in a patient with type B insulin resistance achieved with a combination of immunotherapies. A 55-year-old Japanese man presented with nocturnal hypoglycemia and cytopenia. He also had postprandial hyperglycemia due to severe insulin resistance, which was difficult to manage using high-dose insulin and recombinant human insulin-like growth factor-1. Serological testing showed type B insulin resistance syndrome associated with systemic lupus erythematosus. Glucocorticoids and mycophenolate/azathioprine combination therapy were introduced, resulting in a prompt improvement in glycemic control. The patient has remained in clinical and serological remission for 8 years. Over the past year, he achieved euglycemia with azathioprine monotherapy, without the need for insulin or oral antiglycemic agents.