A case report of tropical diabetic hand syndrome

Tropical diabetic hand syndrome (TDHS) is a complex acute symptom found in unrecognized and underreported diabetes mellitus patients and often resulted from trivial trauma. Poor outcomes of TDHS may range from limb deformity, amputation to death which is associated with delayed treatment. A 40-year-old male with cellulitis and skin erosion on his left arm came to the emergency room. The initial complaint was small blister after a motorcycle accident seven days before admission. Diagnosis of diabetes mellitus, diabetic ketoacidosis (DKA), and TDHS was made. Emergency treatment for DKA was promptly done, followed by an immediate aggressive intravenous broad-spectrum antibiotic with antibiotic against anaerobic bacterial without culture sensitivity test result. The appropriate wound care was done 2 times/day. The patient demonstrated excellent outcome and continued to outpatient care after 13 days of hospitalization. TDHS can be diagnosed inpatient without a history of diabetes mellitus and may be associated with DKA. Immediate and aggressive broad-spectrum intravenous antibiotics, and appropriate wound care should be executed after diagnosis, to achieve a better outcome.