Clinical Presentation and Outcome of Tropical Diabetic Hand Syndrome in Diabetic Patients: A Case Series from Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Abstract

Background: One of the complications of Diabetes Mellitus (DM) - both type 1(T1DM) and type 2 (T2DM) is Tropical diabetic hand syndrome (TDHS). The initiating event ranges from trivial trauma to overt injury to the hand in the presence of hyperglycaemia, usually aggravated by poorly treated wounds, superimposed infection and peripheral neuropathy. This case series aims to highlight the different forms of presentation of TDHS and their outcomes.

Materials and methods: This is a case series that reviewed four cases of TDHS managed at the Endocrine Unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over an 11 months period from August 2023 to June 2024. Out of seven identified cases, four with complete treatment records were included.

Results: Case 1: A 24-year-old female single lady with a 2-week history of a stick injury to the left hand presented with a random blood sugar (RBS) of 22.2 mmol/L, swelling, ulcers, and pus discharge. Staphylococcus spp. was cultured from the wound. She was treated with antibiotics and underwent debridement. Case 2: A 20-year-old female trader presented with a 2-weeks history of spontaneous blisters on the right hand with an RBS of 22.5mmol/L, she exhibited similar symptoms as case 1. Staphylococcus spp. was also cultured. She had antibiotics and debridement. Case 3: A 44-year-old male butcher presented with a 3-weeks history of a knife injury to the left hand, along with swelling, ulcers, pus, and gangrene with an RBS of 18.5mmol/L. He required debridement and subsequent amputation. Case 4: A 49 year-old widow, a known T2DM, and Hypertensive heart failure patient who presented with left hand swelling and ulceration from the cannula site. She eventually died from multiple organ failure.

Conclusion: TDHS remains a serious and preventable complication among diabetic patients in tropical regions. This case series underscores the importance of educating patients on hand care in addition to other forms of diabetic education to prevent severe outcomes such as gangrene and amputation.