Tropical diabetic hand syndrome, a common but unknown pathology

Abstract

Introduction. Out of 10 patients with diabetes mellitus, 4 could have significant hand injuries that require timely medical evaluation. Here we report a rare condition called tropical diabetic hand syndrome (TDHS), its classification and treatment of a case in the Mosquitia region of Honduras. TDHS is defined as any adult diagnosed with diabetes mellitus presenting with cellulitis, abscess and/or gangrene in any region of the hand and upper limb. Case presentation. A 22-year-old woman with diabetes mellitus type 1 attended Hospital de Puerto Lempira on two occasions in a period of 4 months. She showed up with inflammatory changes in her right hand, which she attributed to an unnoticed injury while doing her daily activities. Multiple surgical interventions and broad-spectrum antibiotic treatment were necessary to control the injury. Discussion. The term TDHS is rarely used to designate inflammatory changes in the hands of diabetic patients living in tropical countries. Compared to the diabetic foot, TDHS occurs in a 20:1 ratio, and it’s not uncommon to see a rapid spread of infection through the hand and forearm compartments, with Meleney's gangrene its complication. Conclusion. TDHS must be treated aggressively from the beginning given its rapid evolution to complications. A complementary therapy must be integrated.