Tropical Diabetic Hand Syndrome: A Case Report and Literature Review

Abstract

Tropical diabetic hand syndrome (THDS) is an acute complication that mainly affects patients with diabetes living in the tropics. The cause is usually unknown, but it is often preceded by minor trauma to the hand. Other risk factors for TDHS are poor glycaemic control, poorly treated wounds, malnutrition, and diabetic neuropathy. Early signs include swelling and ulceration of the hand. It can rapidly progress to sepsis and may further worsen, leading to deformity, disability, and amputation. If not treated promptly, death may occur. Unlike diabetic foot ulcer, TDHS often goes unreported. Here is a case of a 39-year-old female and a known patient with diabetes who presented to the outpatient department with swelling and tenderness of the left hand, along with foul-smelling purulent discharge. It began after the patient peeled off a patch of scaly, thickened skin over the distal part of their middle finger. Investigations showed high blood sugar and slightly increased leukocyte count. The patient was started on antihyperglycaemic medications and intravenous antibiotics. Urgent surgical debridement was done, which led to amputation of the middle finger. Thereafter, the patient showed significant improvement and was discharged with follow-up instructions. This case report emphasises the importance of timely intervention in cases of tropical diabetic hand syndrome, and the need for adequate patient education on this issue.