Understanding diabetic cheiroarthropathy: a focus on clinical presentation.

Diabetic cheiroarthropathy (DCA) is a relatively uncommon and underdiagnosed complication of poorly controlled diabetes. It is caused by non-enzymatic glycation of collagen that ultimately leads to microvascular damage and polyarticular stiffness. If diagnosed early, optimal management of serum glucose levels may lessen joint stiffness and prevent microvascular and macrovascular complications associated with diabetes mellitus. We review the case of a 55-year-old male with type 2 diabetes mellitus who was diagnosed with DCA after complaints of chronic joint stiffness and immobility.

Tropical diabetic hand syndrome in a Solomons Islands adult: A case report of a rare complication.

BACKGROUND: Tropical diabetic hand syndrome (TDHS) is a rare and often unrecognized complication that can lead to lifelong disability or even death among diabetic patients living in the tropics. PRESENTATION OF CASE: This study reports the case of a 47-year-old male patient in the Solomon Islands who developed TDHS caused by Klebsiella pneumonia. The patient presented with symptoms of localized cellulitis of the fourth digit of the left hand after being discharged 10.5 weeks prior for an infection on the second digit of the left hand. Subsequent physical exams, surgical debridement, and patient monitoring indicated that the cellulitis spread and developed into necrotizing fasciitis. Despite serial surgical debridement and a fasciotomy, as well as administration of antidiabetic agents and antibiotics, the patient developed sepsis and died forty-five days post-admission. DISCUSSION: Medication shortages, late presentation, and failure to pursue aggressive surgery increases risk of TDHS patient morbidity and mortality. CONCLUSION: TDHS requires early detection and presentation, aggressive surgical management, and efficient administration of antidiabetic agents and intravenous antibiotics.

Diabetic Cheiroarthropathy in Type 1 Diabetes Mellitus and Coeliac Disease.

Diabetes mellitus can be associated with a variety of musculoskeletal disorders. Diabetic cheiroarthropathy or diabetic hand syndrome is one of the complications encountered in long-standing uncontrolled diabetes. It is characterized by limited movement of the joints of the hands along with thickening of the skin on the palmar and dorsal surfaces. There is an association between diabetic cheiroarthropathy and microvascular complications of diabetes, most commonly diabetic retinopathy. Early diagnosis of cheiroarthropathy can give the clinician an opportunity to screen for microvascular complications. Cheiroarthropathy is usually a clinical diagnosis. Treatment involves achievement of good glycemic control along with physiotherapy and occupational therapy. We have described the case of a 16-year-old adolescent male with uncontrolled type 1 diabetes and coeliac disease who presented to us with diabetic cheiroarthropathy.

Tropical diabetic hand syndrome: a case report.

BACKGROUND: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis. CASE PRESENTATION: We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis. CONCLUSION: Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

Tropical Diabetic Hand Syndrome.

Any adult with diabetes in the tropics with hand cellulitis, infection and gangrene qualifies for tropical diabetic hand syndrome (TDHS). We reviewed a 39-year-old woman with a 3-week history of swelling of the left index finger following an insect bite. The swelling progressively increased in size, was very painful, and extended to the palm. There was no history or symptoms suggestive of chronic complications of diabetes. Random blood sugar on presentation was above 600 mg/dl using a glucometer. Examination revealed an edematous left palm draining pus from multiple sinuses, necrotic and gangrenous left index finger extending down to just above the thenar eminence. A diagnosis of TDHS in a patient with hyperosmolar state was made. She was managed accordingly and subsequently underwent aggressive debridement and desloughing. Two fingers were amputated and the wound was allowed to heal by secondary intention.