Hydroxychloroquine sulfate related hypoglycemia in a non-diabetic COVID-19 patient: a case report and literature review.

Imanova Yaghji, Narimana; Kan, Elif Kilic; Akcan, Songul; Colak, Ramis; Atmaca, Aysegul

OBJECTIVE Hypoglycemia is a serious adverse effect of hydroxychloroquine (HCQ) which is very rare in non-diabetic patients. This case report describes a non-diabetic patient without any other chronic diseases, who experienced mild hypoglycemia related to HCQ used for COVID-19 treatment. METHODS All etiologies causing hypoglycemia were investigated and a 72-hour fast test was performed. RESULTS A 34-years old male patient was admitted to our hospital with a high fever, cough, and chest pain. The result of his COVID-19 PCR test was positive. He received HCQ for 10 days for the treatment of COVID-19 infection. He experienced fatigue, dizziness, severe headache, weakness and feeling of hunger after discontinuation of HCQ during his isolation at home. Before COVID-19 infection, he never experienced hypoglycemia symptoms. He did not have a history of chronic diseases, drug use, alcohol consumption or smoking. A Seventy two-hour fasting test was performed. He complained about headache and weakness during the 72 hours test period. The PG level was determined as 49 mg/dl during these symptoms. Concurrent insulin and C-peptide levels were <2 mU/mL and 0.553 ng/mL, respectively. ACTH, cortisol, growth hormone, liver and kidney function tests were normal. HbA1c level was 4.7% (28 mmol/mol) (Normal Range %4,5-5,7). CONCLUSION Hypoglycemia may be observed as an adverse effect of HCQ used for COVID-19 infection even in patients without chronic diseases and comorbidities. We must be careful while using HCQ for these patients and must warn them about this effect. The warning about hypoglycemia effect of HCQ must be added to COVID-19 treatment guidelines.