Browse

You are looking at 1 - 10 of 15 items for :

  • Patient Demographics x
  • Gland/Organ x
  • Dermatology x
Clear All
Jenny S W Yun Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Search for other papers by Jenny S W Yun in
Google Scholar
PubMed
Close
,
Chris McCormack Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Search for other papers by Chris McCormack in
Google Scholar
PubMed
Close
,
Michelle Goh Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Search for other papers by Michelle Goh in
Google Scholar
PubMed
Close
, and
Cherie Chiang Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
University of Melbourne, Parkville, Victoria, Australia

Search for other papers by Cherie Chiang in
Google Scholar
PubMed
Close

Summary

Acanthosis nigricans (AN) is a common dermatosis associated with hyperinsulinemia and insulin resistance. However, AN has been rarely reported in patients with insulinoma, a state of persistent hyperinsulinemia. We present a case of metastatic insulinoma, in whom AN manifested after the first cycle of peptide receptor radionuclide therapy (PRRT). A 40-year-old man was diagnosed with metastatic insulinoma after 5 months of symptomatic hypoglycemia. Within 1 month post PRRT, the patient became euglycemic but developed a pigmented, pruritic rash which was confirmed on biopsy as AN. We discuss the rare manifestation of AN in subjects with insulinoma, the role of insulin in the pathogenesis of AN, malignant AN in non-insulin-secreting malignancies and association with other insulin-resistant endocrinopathies such as acromegaly.

Learning points

  • Acanthosis nigricans (AN) is a common dermatosis which is typically asymptomatic and associated with the hyperinsulinemic state.

  • Malignant AN can rapidly spread, cause pruritus and affect mucosa and the oral cavity.

  • AN is extremely rare in patients with insulinoma despite marked hyperinsulinemia.

  • Peptide receptor radionuclide therapy might have triggered TGF-α secretion in this subject which led to malignant AN.

  • Rapid spread or unusual distribution of pruritic AN warrants further investigation to exclude underlying malignancy.

Open access
Ricaurte Crespo-Trevino Universidad de Monterrey, Monterrey, Mexico
Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA

Search for other papers by Ricaurte Crespo-Trevino in
Google Scholar
PubMed
Close
,
Jade Schiffman Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA

Search for other papers by Jade Schiffman in
Google Scholar
PubMed
Close
,
Shoaib Ugradar Cedars-Sinai Medical Center, Los Angeles, California, USA

Search for other papers by Shoaib Ugradar in
Google Scholar
PubMed
Close
,
Kimberly Cockerham Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA

Search for other papers by Kimberly Cockerham in
Google Scholar
PubMed
Close
,
Raymond Douglas The Jules Stein Eye Institute University of California, Los Angeles, California, USA

Search for other papers by Raymond Douglas in
Google Scholar
PubMed
Close
,
David de Leon-Garza Universidad de Monterrey, Monterrey, Mexico

Search for other papers by David de Leon-Garza in
Google Scholar
PubMed
Close
, and
Rosa Tang Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA

Search for other papers by Rosa Tang in
Google Scholar
PubMed
Close

Summary

Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quality of life in certain cases. Currently, the available treatments offer limited results and a chance of recurrence. Teprotumumab, a novel medication that results in the regression of thyroid ophthalmopathy, may have similar effects on dermopathy. We describe four patients treated with teprotumumab for their thyroid ophthalmopathy who concomitantly had dermatopathy upon initiation of their infusions. Patients improved after two to three infusions and three out of the four patients have not suffered a recurrence.Teprotumumab is a monoclonal antibody (MAB) that attenuates an inflammatory response, resulting in decreased edema and tissue expansion. Given the similarities of their pathophysiology, we believe that the resolution of thyroid dermatopathy and regression of thyroid eye disease occurs via the same mechanism. We encourage further investigation utilizing teprotumumab for patients whose dermopathy is associated with impaired quality of life.

Learning points

  • Thyroid dermopathy (TD), an uncommon manifestation of thyroid disease, may occasionally impair function and quality of life.

  • There are only a few treatments for TD, with limited results and high rates of recurrence.

  • Teprotumumab is a Food and Drug Administration-approved medication used for thyroid eye disease (TED).

  • Our patients treated with teprotumumab for TED showed improvement of TD, which demonstrates its potential use for this condition.

Open access
Joana Lima Ferreira Endocrinology Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal

Search for other papers by Joana Lima Ferreira in
Google Scholar
PubMed
Close
,
Francisco Simões de Carvalho Endocrinology Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal

Search for other papers by Francisco Simões de Carvalho in
Google Scholar
PubMed
Close
,
Ana Paula Marques Endocrinology Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal

Search for other papers by Ana Paula Marques in
Google Scholar
PubMed
Close
, and
Rosa Maria Príncipe Endocrinology Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal

Search for other papers by Rosa Maria Príncipe in
Google Scholar
PubMed
Close

Summary

Autoimmune polyglandular syndrome type 1 (APS-1) is a very rare autoimmune entity, accounting for about 400 cases reported worldwide. It is characterized by the presence of at least two of three cardinal components: chronic mucocutaneous candidiasis (CMC), hypoparathyroidism and Addison’s disease. It typically manifests in childhood with CMC and years later with hypoparathyroidism. A 50-year-old man was referred to the Endocrinology outpatient clinic due to irregular follow-up of primary hypoparathyroidism diagnosed at age 7. Previous analysis reported frequent fluctuations of calcium and phosphate levels and persistent hypercalciuria. He presented several comorbidities, including bilateral cataracts, other ocular disorders, transient alopecia and chronic gastritis. Due to weight loss, fatigue, gastrointestinal complaints and the findings at objective examination, Addison’s disease and CMC were investigated and confirmed. Antifungal therapy and hormonal replacement were started with evident clinical improvement. Regarding hypoparathyroidism, calcium-phosphate product decreased and other extraskeletal calcifications were diagnosed, such as nephrolithiasis and in basal ganglia. Further evaluation by genetic analysis revealed homozygosity for a frameshift mutation considered to be a pathogenic variant. It was reported only in two Asian siblings in compound heterozygosity. This case highlights the broad phenotypic spectrum of APS-1 and the significative intra-familial phenotype variability. A complete clinical history taking and high index of suspicion allowed the diagnosis of this rare entity. This case clarifies the need for regular long-term follow-up. In the specific case of hypoparathyroidism and Addison’s disease in combination, the management of APS-1 can be complex.

Learning points:

  • Autoimmune polyglandular syndrome type 1 (APS-1) is a deeply heterogeneous genetic entity with a broad spectrum of clinical manifestations and a significant intra-family phenotypic variability.

  • Early diagnosis of APS-1 is challenging but clinically relevant, as endocrine and non-endocrine manifestations may occur during its natural history.

  • APS-1 should be considered in cases of acquired hypoparathyroidism, and even more so with manifestations with early onset, family history and consanguinity.

  • APS-1 diagnosis needs a high index of suspicion. Key information such as all the comorbidities and family aspects would never be valued in the absence of a complete clinical history taking.

  • Especially in hypoparathyroidism and Addison’s disease in combination, the management of APS-1 can be complex and is not a matter of simply approaching individually each condition.

  • Regular long-term monitoring of APS-1 is essential. Intercalary contact by phone calls benefits the control of the disease and the management of complications.

Open access
Agnieszka Łebkowska Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine

Search for other papers by Agnieszka Łebkowska in
Google Scholar
PubMed
Close
,
Anna Krentowska Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine

Search for other papers by Anna Krentowska in
Google Scholar
PubMed
Close
,
Agnieszka Adamska Department of Endocrinology, Diabetology and Internal Medicine

Search for other papers by Agnieszka Adamska in
Google Scholar
PubMed
Close
,
Danuta Lipińska Department of Endocrinology, Diabetology and Internal Medicine

Search for other papers by Danuta Lipińska in
Google Scholar
PubMed
Close
,
Beata Piasecka Department of Endocrinology, Diabetology and Internal Medicine

Search for other papers by Beata Piasecka in
Google Scholar
PubMed
Close
,
Otylia Kowal-Bielecka Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland

Search for other papers by Otylia Kowal-Bielecka in
Google Scholar
PubMed
Close
,
Maria Górska Department of Endocrinology, Diabetology and Internal Medicine

Search for other papers by Maria Górska in
Google Scholar
PubMed
Close
,
Robert K Semple Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

Search for other papers by Robert K Semple in
Google Scholar
PubMed
Close
, and
Irina Kowalska Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine

Search for other papers by Irina Kowalska in
Google Scholar
PubMed
Close

Summary

Type B insulin resistance syndrome (TBIR) is characterised by the rapid onset of severe insulin resistance due to circulating anti-insulin receptor antibodies (AIRAs). Widespread acanthosis nigricans is normally seen, and co-occurrence with other autoimmune diseases is common. We report a 27-year-old Caucasian man with psoriasis and connective tissue disease who presented with unexplained rapid weight loss, severe acanthosis nigricans, and hyperglycaemia punctuated by fasting hypoglycaemia. Severe insulin resistance was confirmed by hyperinsulinaemic euglycaemic clamping, and immunoprecipitation assay demonstrated AIRAs, confirming TBIR. Treatment with corticosteroids, metformin and hydroxychloroquine allowed withdrawal of insulin therapy, with stabilisation of glycaemia and diminished signs of insulin resistance; however, morning fasting hypoglycaemic episodes persisted. Over three years of follow-up, metabolic control remained satisfactory on a regimen of metformin, hydroxychloroquine and methotrexate; however, psoriatic arthritis developed. This case illustrates TBIR as a rare but severe form of acquired insulin resistance and describes an effective multidisciplinary approach to treatment.

Learning points:

  • We describe an unusual case of type B insulin resistance syndrome (TBIR) in association with mixed connective tissue disease and psoriasis.

  • Clinical evidence of severe insulin resistance was corroborated by euglycaemic hyperinsulinaemic clamp, and anti-insulin receptor autoantibodies were confirmed by immunoprecipitation assay.

  • Treatment with metformin, hydroxychloroquine and methotrexate ameliorated extreme insulin resistance.

Open access
Silvia M Becerra-Bayona Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga – UNAB, Bucaramanga, Colombia

Search for other papers by Silvia M Becerra-Bayona in
Google Scholar
PubMed
Close
,
Víctor Alfonso Solarte-David Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga – UNAB, Bucaramanga, Colombia

Search for other papers by Víctor Alfonso Solarte-David in
Google Scholar
PubMed
Close
,
Claudia L Sossa Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga – UNAB, Bucaramanga, Colombia
Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia

Search for other papers by Claudia L Sossa in
Google Scholar
PubMed
Close
,
Ligia C Mateus Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia

Search for other papers by Ligia C Mateus in
Google Scholar
PubMed
Close
,
Martha Villamil Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia

Search for other papers by Martha Villamil in
Google Scholar
PubMed
Close
,
Jorge Pereira Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia

Search for other papers by Jorge Pereira in
Google Scholar
PubMed
Close
, and
Martha L Arango-Rodríguez Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia

Search for other papers by Martha L Arango-Rodríguez in
Google Scholar
PubMed
Close

Summary

Diabetic foot ulcer morbidity and mortality are dramatically increasing worldwide, reinforcing the urgency to propose more effective interventions to treat such a devastating condition. Previously, using a diabetic mouse model, we demonstrated that administration of bone marrow mesenchymal stem cells derivatives is more effective than the use of bone marrow mesenchymal stem cells alone. Here, we used the aforementioned treatments on three patients with grade 2 diabetic foot ulcers and assessed their beneficial effects, relative to the conventional approach. In the present study, two doses of cell derivatives, one dose of mesenchymal stem cells or one dose of vehicle (saline solution with 5% of human albumin), were intradermally injected around wounds. Wound healing process and changes on re-epithelialization were macroscopically evaluated until complete closure of the ulcers. All ulcers were simultaneously treated with conventional treatment (PolyMen® dressing). Patients treated with either cell derivatives or mesenchymal stem cells achieved higher percentages of wound closure in shorter times, relative to the patient treated with the conventional treatment. The cell derivative and mesenchymal stem cells approaches resulted in complete wound closure and enhanced skin regeneration at some point between days 35 and 42, although no differences between these two treatments were observed. Moreover, wounds treated with the conventional treatment healed after 161 days. Intradermal administration of cell derivatives improved wound healing to a similar extent as mesenchymal stem cells. Thus, our results suggest that mesenchymal stem cell derivatives may serve as a novel and potential therapeutic approach to treat diabetic foot ulcers.

Learning points:

  • In diabetic mouse models, the administration of mesenchymal stem cells derivatives have been demonstrated to be more effective than the use of marrow mesenchymal stem cells alone.

  • Mesenchymal stem cells have been explored as an attractive therapeutic option to treat non-healing ulcers.

  • Mesenchymal stem cells derivatives accelerate the re-epithelialization on diabetic foot ulcers.

Open access
Daramjav Narantsatsral Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Daramjav Narantsatsral in
Google Scholar
PubMed
Close
,
Takagi Junko Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Takagi Junko in
Google Scholar
PubMed
Close
,
Iwayama Hideyuki Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan

Search for other papers by Iwayama Hideyuki in
Google Scholar
PubMed
Close
,
Inukai Daisuke Department of Otolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan

Search for other papers by Inukai Daisuke in
Google Scholar
PubMed
Close
,
Takama Hiroyuki Department of Dermatology, Aichi Medical University School of Medicine, Nagakute, Japan

Search for other papers by Takama Hiroyuki in
Google Scholar
PubMed
Close
,
Nomura Yuka Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Nomura Yuka in
Google Scholar
PubMed
Close
,
Hirase Syo Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Hirase Syo in
Google Scholar
PubMed
Close
,
Morita Hiroyuki Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Morita Hiroyuki in
Google Scholar
PubMed
Close
,
Otake Kazuo Division of Endocrinology and Metabolism, Department of Internal Medicine

Search for other papers by Otake Kazuo in
Google Scholar
PubMed
Close
,
Ogawa Tetsuya Department of Otolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan

Search for other papers by Ogawa Tetsuya in
Google Scholar
PubMed
Close
, and
Takami Akiyoshi Department of Hematology, Aichi Medical University School of Medicine, Nagakute, Japan

Search for other papers by Takami Akiyoshi in
Google Scholar
PubMed
Close

Summary

Dupilumab an inhibitor of the interleukin (IL)-4R-alpha subunit is used for the treatment of allergic diseases. The patient was a 49-year-old man who received dupilumab for the treatment of severe atopic dermatitis. He presented hyperthyroidism with elevated thyroglobulin and anti-thyroid antibody negativity at 4 months after the initiation of therapy. On scintigraphy, the thyroid radioiodine uptake was low. Ultrasonography showed a diffuse hypoechoic area in the thyroid gland. A pathological study revealed lymphocytic infiltration. The administration of dupilumab was continued because of his atopic dermatitis that showed an excellent response. The patient`s hyperthyroidism changed to hypothyroidism 3 weeks later. Six months later his thyroid function normalized without any treatment. We herein describe the case of a patient with atopic dermatitis who developed painless thyroiditis under treatment with dupilumab. To the best of our knowledge, this is the first report of this event in the literature.

Learning points:

  • Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, has been shown to be effective in the treatment atopic dermatitis and asthma with eosinophilia.

  • Painless thyroiditis is characterized by transient hyperthyroidism and hypothyroidism and recovery without anti-thyroid treatment.

  • This is the first report of painless thyroiditis as an adverse effect of dupilumab, although conjunctivitis and nasopharyngitis are the main adverse effects of dupilumab.

Open access
Waralee Chatchomchaun Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Waralee Chatchomchaun in
Google Scholar
PubMed
Close
,
Yotsapon Thewjitcharoen Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Yotsapon Thewjitcharoen in
Google Scholar
PubMed
Close
,
Karndumri Krittadhee Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Karndumri Krittadhee in
Google Scholar
PubMed
Close
,
Veekij Veerasomboonsin Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Veekij Veerasomboonsin in
Google Scholar
PubMed
Close
,
Soontaree Nakasatien Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Soontaree Nakasatien in
Google Scholar
PubMed
Close
,
Sirinate Krittiyawong Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Sirinate Krittiyawong in
Google Scholar
PubMed
Close
,
Sriurai Porramatikul Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Sriurai Porramatikul in
Google Scholar
PubMed
Close
,
Ekgaluck Wanathayanoroj Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Ekgaluck Wanathayanoroj in
Google Scholar
PubMed
Close
,
Auchai Kanchanapituk Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Auchai Kanchanapituk in
Google Scholar
PubMed
Close
,
Pairoj Junyangdikul Department of Pathology, Samitivej Srinakarin Hospital, Bangkok Hospital Group, Bangkok, Thailand

Search for other papers by Pairoj Junyangdikul in
Google Scholar
PubMed
Close
, and
Thep Himathongkam Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand

Search for other papers by Thep Himathongkam in
Google Scholar
PubMed
Close

Summary

In this case report, we describe a 37-year-old male who presented with fever and tender neck mass. Neck ultrasonography revealed a mixed echogenic multiloculated solid-cystic lesion containing turbid fluid and occupying the right thyroid region. Thyroid function tests showed subclinical hyperthyroidism. The patient was initially diagnosed with thyroid abscess and he was subsequently treated with percutaneous aspiration and i.v. antibiotics; however, his clinical symptoms did not improve. Surgical treatment was then performed and a pathological examination revealed a ruptured epidermoid cyst with abscess formation. No thyroid tissue was identified in the specimen. The patient was discharged uneventfully. However, at the 3-month and 1-year follow-ups, the patient was discovered to have developed subclinical hypothyroidism. Neck ultrasonography revealed a normal thyroid gland. This report demonstrates a rare case of epidermoid cyst abscess in the cervical region, of which initial imaging and abnormal thyroid function tests led to the erroneous diagnosis of thyroid abscess.

Learning points:

  • Epidermoid cyst abscess at the cervical region can mimic thyroid abscess.

  • Neck ultrasonography cannot distinguish thyroid abscess from epidermoid cyst abscess.

  • Thyroid function may be altered due to the adjacent soft tissue inflammation.

Open access
Aishah Ekhzaimy Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Aishah Ekhzaimy in
Google Scholar
PubMed
Close
,
Afshan Masood Obesity Research Center, and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Afshan Masood in
Google Scholar
PubMed
Close
,
Seham Alzahrani Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Seham Alzahrani in
Google Scholar
PubMed
Close
,
Waleed Al-Ghamdi Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Waleed Al-Ghamdi in
Google Scholar
PubMed
Close
,
Daad Alotaibi Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Daad Alotaibi in
Google Scholar
PubMed
Close
, and
Muhammad Mujammami Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia

Search for other papers by Muhammad Mujammami in
Google Scholar
PubMed
Close

Summary

Central diabetes insipidus (CDI) and several endocrine disorders previously classified as idiopathic are now considered to be of an autoimmune etiology. Dermatomyositis (DM), a rare autoimmune condition characterized by inflammatory myopathy and skin rashes, is also known to affect the gastrointestinal, pulmonary, and rarely the cardiac systems and the joints. The association of CDI and DM is extremely rare. After an extensive literature search and to the best of our knowledge this is the first reported case in literature, we report the case of a 36-year-old male with a history of CDI, who presented to the hospital’s endocrine outpatient clinic for evaluation of a 3-week history of progressive facial rash accompanied by weakness and aching of the muscles.

Learning points:

  • Accurate biochemical diagnosis should always be followed by etiological investigation.

  • This clinical entity usually constitutes a therapeutic challenge, often requiring a multidisciplinary approach for optimal outcome.

  • Dermatomyositis is an important differential diagnosis in patients presenting with proximal muscle weakness.

  • Associated autoimmune conditions should be considered while evaluating patients with dermatomyositis.

  • Dermatomyositis can relapse at any stage, even following a very long period of remission.

  • Maintenance immunosuppressive therapy should be carefully considered in these patients.

Open access
Ilaria Teobaldi Division of Endocrinology Diabetes and Metabolism, Department of Medicine

Search for other papers by Ilaria Teobaldi in
Google Scholar
PubMed
Close
,
Vincenzo Stoico Division of Endocrinology Diabetes and Metabolism, Department of Medicine

Search for other papers by Vincenzo Stoico in
Google Scholar
PubMed
Close
,
Fabrizia Perrone Division of Endocrinology Diabetes and Metabolism, Department of Medicine

Search for other papers by Fabrizia Perrone in
Google Scholar
PubMed
Close
,
Massimiliano Bruti Division of Plastic Surgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Massimiliano Bruti in
Google Scholar
PubMed
Close
,
Enzo Bonora Division of Endocrinology Diabetes and Metabolism, Department of Medicine

Search for other papers by Enzo Bonora in
Google Scholar
PubMed
Close
, and
Alessandro Mantovani Division of Endocrinology Diabetes and Metabolism, Department of Medicine

Search for other papers by Alessandro Mantovani in
Google Scholar
PubMed
Close

Summary

Honey has been used as a wound dressing for hundreds of years by ancient civilizations, but only recently it has acquired scientific interest because of its relevant biological properties. In the last decade, indeed, several trials and observational studies have reported that, compared to conventional treatment (e.g. antiseptics, polyurethane film, paraffin gauze, soframycin-impregnated gauze), honey dressings seem to be better in healing time of different types of wounds, including diabetic foot ulcers. However, to date, information about a potential favorable biological effect of honey dressings on diabetic ulcers with exposed tendon are still scarce. Notably, foot or leg ulcers with exposed tendon are serious complications in patients with type 2 diabetes, as they are associated with an increased risk of adverse outcome. Therefore, the use of effective and safe treatments to bring these lesions to timely healing is very important in clinical practice. We herein report the case of a Caucasian adult patient with type 2 diabetes presenting a chronic right posterior lower limb ulcer (Texas University Classification (TUC) 2D) with tendon exposure that was successfully treated with honey dressings (glucose oxidase (GOX) positive with peroxide activity) in addition to systemic antibiotic therapy, surgical toilette and skin graft. In our case, the use of honey dressing for treating exposed tendon tissue probably allowed the timely wound healing. Although further studies are required, such treatment may constitute part of the comprehensive management of diabetic wounds, including those with tendon exposure, and should be considered by clinicians in clinical practice.

Learning points:

  • Honey has been used as a wound dressing for hundreds of years, but only recently it has acquired scientific interest for its biological properties.

  • Several studies have documented that, compared to conventional dressings, honey seems to be better in healing time of different types of wounds, including diabetic foot ulcers.

  • Our case report is the first to highlight the importance to use honey dressings also for the treatment of ulcers with tendon exposure in patients with type 2 diabetes, suggesting that this kind of dressing should be considered by clinicians in clinical practice.

Open access
Clarissa Ern Hui Fang Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland

Search for other papers by Clarissa Ern Hui Fang in
Google Scholar
PubMed
Close
,
Mohammed Faraz Rafey Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland

Search for other papers by Mohammed Faraz Rafey in
Google Scholar
PubMed
Close
,
Aine Cunningham Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland

Search for other papers by Aine Cunningham in
Google Scholar
PubMed
Close
,
Sean F Dinneen Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland

Search for other papers by Sean F Dinneen in
Google Scholar
PubMed
Close
, and
Francis M Finucane Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland

Search for other papers by Francis M Finucane in
Google Scholar
PubMed
Close

Summary

A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with ‘ketosis-prone diabetes’ (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised.

Learning points:

  • Risperidone-induced diabetic ketoacidosis (DKA) is not synonymous with type 1 diabetes, even in young white patients and may be a manifestation of ‘ketosis-prone’ type 2 diabetes (KPD).

  • KPD is often only confirmed after the initial presentation, when islet autoimmunity and cautious phasing out of insulin therapy have been assessed, and emergency DKA management remains the same.

  • As in other cases of KPD, a family history of T2DM and presence of cutaneous markers of insulin resistance were important clinical features suggestive of an alternative aetiology for DKA.

Open access