Diabetic foot ulcer with overlap syndrome: A case report and review of literature.

Background: Diabetic foot ulcer (DFU) is a common and serious complication among individuals with diabetes. However, the co-occurrence of DFU with overlap syndrome, particularly involving anti-synthetase syndrome (ASS) and systemic sclerosis (SSc), is exceptionally rare.

Case summary: We report a case of overlap syndrome (ASS and SSc) with diabetes manifesting as biped gangrene. The patient, a 60-year-old female, presented with painful ulcers on both heels that had persisted for nine months. She was diagnosed with DFU, which was likely attributable to SSc, suboptimal long-term glycemic control, and glucocorticoid therapy. Following four months of treatment, the patient demonstrated significant improvement and was subsequently discharged. At the one-year follow-up, the patient developed new cyanotic ulcers on the right 4^th and 5^th toes ten months post-discharge that resolved completely within 3 months following conservative management. The four-year follow-up revealed persistent intermittent cyanosis without ulcer recurrence, although progressive interstitial lung disease necessitated prolonged bed rest.

Conclusion: SSc-related foot ulcers demonstrate favorable outcomes when managed with conventional wound care combined with vasoactive agents.