Transient diabetes insipidus with elevated serum osmolarity associated with 'benign' febrile illness
S. G. Dorfman, G. W. Ruark, Z. S. Agus, R. L. Jacobs and R. L. Young
A 38-year-old physician developed polyuria and hypodipsia four days after
the onset of an upper respiratory tract infection. Subsequent investigation
showed a concentration defect with dehydration that partially corrected
with vasopressin injection (Pitressin) administration compatible with
partial central diabetes insipidus (DI). Skull roentgenograms, EEG, and
lumbar puncture were normal. The polyuria and hypodipsia slowly resolved
without treatment. Normal urinary concentration ability was achieved by the
48th day, but a residual elevation in serum osmolarity persisted for one
year. Review of the literature failed to show previous documentation of
transient DI with elevated serum osmolarity from an acute, febrile illness.
The mechanism is speculative, but may be related to a subclinical
encephalitis. The true frequency of this syndrome and its relationship to
the frequent observation of transient polydipsia and polyuria in "benign"
febrile illness remains to be determined.