Case report of a person with diabetes mellitus who has tropical diabetic hand syndrome

Abstract

-Introduction: Diabetes mellitus (DM) is a chronic systemic disease that causes morbidity and mortality. Diabetes often increases the incidence and severity of various infections, especially those caused by bacteria and fungi, where patients have hyperglycemia and poor blood sugar control. Tropical diabetic hand syndrome (TDHS) is a specific hand complication experienced by people with DM in tropical countries. The syndrome involves localized cellulitis, which can be progressive and fulminant to hand sepsis and gangrene. Management of patients with TDHS requires a comprehensive strategy and management to reduce mortality and morbidity. This study aimed to report a rare case of a patient with T2DM who experienced TDHS. Case Presentation: A 45-year-old man came to the emergency department of RSUD Dr. Soetomo, with a chief complaint of a wound on his right hand caused by a rusty nail that had not healed for three days. The patient said that he had uncontrolled DM for six years. In manus dextra examination, an ulcer measuring 0.5x 0.5 cm was found on the back of the hand on the ulnar side, with edema, hyperemia, and active pus discharge. The patient was hospitalized for nine days and discharged when the complaints and the blood sugar level were improved. On the seventh day after discharge, the complaints felt significantly reduced, the wound improved with granulation tissue appearing, and the blood sugar level was within normal limits. The patient was given insulin aspart injection of 10 units thrice daily, basal insulin of 16 units, ciprofloxacin 500 mg twice daily, ibuprofen 400 mg thrice daily, and cilostazol 100 mg twice daily. Conclusion: In this case report, we presented a case of a 45-year-old man with manifestations of TDHS as a complication of uncontrolled DM for six years and delay in obtaining medical services. Management of patients with TDHS includes hospitalization, elevation of the affected hand, optimal blood sugar control, administration of antibiotics, and wound care. Education for T2DM complications remains the most important preventive measure in developing countries.