Tropical diabetic hand syndrome with septicaemia in a 63-year-old male: a case report and review of the literature

Background: Tropical diabetic hand syndrome (TDHS) is a rare complication of diabetes mellitus prevalent in tropical regions. It is characterized by localized swelling, cellulitis, and ulceration of the hand. A high index of suspicion, prompt and aggressive surgical intervention, tight glycaemic control as well as parenteral antibiotic therapy are the hallmarks of effective management of this potentially fatal complication of diabetes mellitus. The aim of this paper is to report a case of tropical diabetic hand syndrome with septicaemia. Case Report: A 63-year-old male carpenter who was not previously known to be diabetic presented with a history of a trivial nail puncture to his left middle finger 5 weeks before arrival in hospital. Examination revealed features of septic shock, dehydration and hyperglycaemia. Prompt resuscitation was followed by commencement of parenteral antibiotics, insulin therapy and drainage with serial debridement. A split skin graft was used to cover the residual defect on the dorsum of the left hand after satisfactory control of sepsis. He was discharged home after 73 days in hospital with impaired function of the left hand. Conclusion: This case underscores the importance of heightened clinical suspicion, early recognition, and prompt therapeutic intervention in mitigating the deleterious sequelae of TDHS. It also highlights the importance of patient education initiatives in improving healthcare seeking behaviour and curtailing reliance on alternative healthcare modalities.