Tropical diabetic hand syndrome: a case report

Abstract

BackgroundTropical 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 presentationWe 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.ConclusionThough 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.

A Case With Type 2 Diabetes Mellitus Complicated With Diabetic Hand and Literature Review

“…Bu yayınlarda el enfeksiyonları 'tropikal diyabetik el sendromu' (TDHS) olarak tanımlanmaktadır (15). Klinik prezantasyonu lokalize bir selülitten fatal olabilecek ülsere gangrenöz bir lezyona kadar değişkenlik göstermektedir (16). Tropikal bölgeler dışında nadiren görülmektedir ve vaka bildirimi şeklinde birkaç yayın mevcuttur (17,18).…”

Hands in diabetes

“…Despite vigorous resuscitation, glycaemic control, antibiotics, and debridement, then amputation, she died. 21 Twelve people with tropical diabetic hand syndrome were seen in three years in a Nigerian hospital. Patients were usually women using herbal remedies after minor trauma, with hyperglycaemia, low socioeconomic status, and malnutrition who sought help late (at 23 days on average).…”

Síndrome de mano diabética tropical en un Hospital del Noreste de México: reporte de caso

“…Alteraciones del sistema inmunitario de los leucocitos de pacientes con diabetes 9 los hace propensos a padecer con mayor severidad y frecuencia infección de heridas 10 , incluso heridas triviales pueden dar como resultado SMDT 11 . La fisiopatología del SMDT, así como el área anatómica de la mano, favorecen la diseminación de la infección y la necrosis del tejido.…”