The increase of plasma galectin-9 in a patient with insulin allergy: a case report

Allergic reaction to insulin is known to be associated with eosinophilia and hyper IgE [1]. We studied novel pro-inflammatory molecules such as galectin-9 (GAL-9) and osteopontin (OPN) in a patient with insulin allergy because the involvement of these molecules in eosinophilia has been recently proposed [2,3].OPN is a glycoprotein believed to be involved in Th1 inflammation in various infectious diseases including HIV as we described previously [4]. Recently, it was reported that OPN is synthesized by eosinophils and was elevated in bronchoalveolar lavage (BAL) fluid of asthma patients [2]. GAL-9 is a member of the galectin family of thiol-dependent lectins, and positive GAL-9 staining was observed in drug injured liver tissue [3]. Recently, it was reported that GAL-9 treated NOD mice had decreased populations of Th1 cells and less leukocyte infiltration in islets than the control group indicating that GAL-9 inhibits autoimmune diabetes in NOD mice [5].Here, we measured the plasma OPN and GAL-9 levels in a patient with insulin allergy for the first time. In addition, we also investigated the levels of soluble interleukin2 receptor (sIL-2R), eotaxin-3 and histamine, which are known to be elevated in patients with eosinophilia [6-8].A 65-year old man was referred to our department because of persistent fever on Feb. 2, 2009. The patient was diagnosed as type 2 diabetes mellitus 10 years earlier and was treated with the anti-diabetic drug metformin. He had been suffering from moderate fever since Dec. 10, 2008 and was admitted to a nearby hospital on Dec. 30. After hospitalization, various antibiotics were given due to the elevation of CRP (Table 1). Insulin aspart & insulin aspart 30 mix were also prescribed on Jan. 10, 2009 because HbA1c was also elevated. A sudden increase of the eosinophil count (Table 1) was noted on Jan. 13 and the patient was referred to our hospital for further evaluation on Feb. 2 although the fever had been subsiding. All the antibiotic drugs