title: Tropical diabetic hand syndrome: a case report.
abstract: BACKGROUND
  Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis.
  
  
  METHODS
  We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis.
  
  
  CONCLUSIONS
  Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.
authors.affiliation: Saint Elizabeth Catholic General Hospital and Cardiac Centre Shisong, Kumbo, Cameroon. eugenembinglo@gmail.com.|Clinical Research Education Networking and Consultancy, Douala, Cameroon. eugenembinglo@gmail.com.
authors.forename: Eugene Vernyuy
authors.initials: EV
authors.lastname: Yeika
authors.affiliation: Saint Elizabeth Catholic General Hospital and Cardiac Centre Shisong, Kumbo, Cameroon.
authors.forename: Jacques Cabral
authors.initials: JC
authors.lastname: Tchoumi Tantchou
authors.affiliation: Saint Elizabeth Catholic General Hospital and Cardiac Centre Shisong, Kumbo, Cameroon.|Health and Human Development Research Group, Douala, Cameroon.
authors.forename: Joyce Bei
authors.initials: JB
authors.lastname: Foryoung
authors.affiliation: Health and Human Development Research Group, Douala, Cameroon.|Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
authors.forename: Paul Nkemtendong
authors.initials: PN
authors.lastname: Tolefac
authors.affiliation: Health and Human Development Research Group, Douala, Cameroon.|Banso Baptist Hospital, Kumbo, Cameroon.
authors.forename: Derrick Tembi
authors.initials: DT
authors.lastname: Efie
authors.affiliation: Health and Human Development Research Group, Douala, Cameroon.|Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Siméon Pierre
authors.initials: SP
authors.lastname: Choukem
mesh_terms: D000671:Amputation, Surgical; D048909:Diabetes Complications / Q000473:pathology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006225:Hand / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D013492:Suppuration / Q000473:pathology* / Q000601:surgery
keywords: Case report; Classification; Late diagnosis; Tropical diabetic hand syndrome