# Concomitancy of Type 1 Diabetes in Two Siblings: A Case Report and Review of Possible Viral Etiology

## TL;DR

Two siblings developed type 1 diabetes a month apart, suggesting a possible shared viral trigger.

## Contribution

Highlights a potential link between asymptomatic viral infections and the onset of type 1 diabetes in siblings.

## Key findings

- Two siblings were diagnosed with T1DM a month apart, suggesting a possible shared environmental or infectious trigger.
- The case raises the possibility of asymptomatic enteroviral infections contributing to T1DM onset.
- The findings emphasize the need for further research into environmental contributors to T1DM.

## Abstract

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition with high prevalence in Saudi Arabia. Despite extensive research, the exact etiology remains unclear. Viral infections, particularly enteroviruses like coxsackievirus, have been proposed as potential triggers. In this case report, we describe two siblings who were diagnosed with T1DM a month apart, raising a clinical question regarding possible infectious triggers. We also included a comprehensive literature review of enteroviral contribution to the clinical onset of T1DM. A 17-year-old male, previously healthy, presented to the emergency department with diabetic ketoacidosis (DKA) following a two-day history of shortness of breath, epigastric pain, and fatigue. Laboratory investigations confirmed hyperglycemia, metabolic acidosis, and positive autoantibodies, confirming the diagnosis of T1DM. Remarkably, his 12-year-old younger brother was diagnosed with T1DM one month earlier, following a similar acute presentation. Both siblings denied recent viral symptoms, yet their close living conditions and shared use of objects may suggest the possibility of a common asymptomatic viral infection. The unique clinical presentation of the concomitant onset of T1DM in two siblings suggests a potential shared environmental or infectious trigger. Although both siblings denied a previous history of viral symptoms, the possibility of asymptomatic viral infection is still raised. This case emphasizes the need to explore causation relationships between enteroviruses and clinical T1DM. The findings emphasize the importance of heightened awareness and proactive research to identify and mitigate environmental contributors to T1DM onset. Identifying environmental triggers of T1DM will enable targeted prevention, early detection, and intervention strategies, ultimately reducing the disease burden and improving public health outcomes.