Glucose dysregulation presenting as psychiatric and autoimmune dysfunction: Case investigation

A 13-year-old female presented with positive anti-nuclear antibodies (ANAs) with speckled nuclei, chronic migraine, joint swelling, desquamation, epistaxis, and severe psychiatric symptoms, including multiple hospitalizations for suicide attempts. Despite referrals to various specialists and treatment for generalized anxiety disorder (GAD) and major depressive disorder (MDD), symptoms persisted. Classic autoimmune markers prompted patient referral to rheumatology. However, negative tests for Crohn’s disease, celiac disease, and gluten sensitivity, along with atypical features indicated a non-classical immune etiology. Further testing involving continuous glucose monitoring revealed nocturnal fluctuations, non-feeding glucose spikes, and reactive hypoglycemia, suggesting an underlying metabolic disorder. A very low carbohydrate diet (<15g carbohydrates/day or 5-10% of caloric intake) was prescribed for 3-months. Following dietary intervention, glycemic control examination revealed stabilized glucose levels, body mass index (BMI) reduction, eliminated ANA positivity, and resolved psychiatric and physiological symptoms. This case underscores the potential for glucose dysregulation to contribute to systemic disease states with markers of autoimmunity and psychiatric symptoms, and the value of metabolic assessments in differential diagnosis.