Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Signs and Symptoms

You are looking at 1 - 2 of 2 items for :

Clear All
Yael Lefkovits Wolfson Diabetes Centre, Addenbrooke’s Hospital Cambridge, Cambridge, UK

Search for other papers by Yael Lefkovits in
Google Scholar
PubMed Close
and
Amanda Adler Wolfson Diabetes Centre, Addenbrooke’s Hospital Cambridge, Cambridge, UK

Search for other papers by Amanda Adler in
Google Scholar
PubMed Close

Summary

Necrobiosis lipoidica diabeticorum (NLD) is a chronic granulomatous dermatitis generally involving the anterior aspect of the shin, that arises in 0.3–1.2% of patients with diabetes mellitus (1). The lesions are often yellow or brown with telangiectatic plaque, a central area of atrophy and raised violaceous borders (2). Similar to other conditions with a high risk of scarring including burns, stasis ulcers and lupus vulgaris, NLD provides a favourable environment for squamous cell carcinoma (SCC) formation (3). A number of cases of SCC from NLD have been recorded (3, 4, 5); however, our search of the literature failed to identify any cases of either metastatic or fatal SCC which developed within an area of NLD. This article describes a patient with established type 1 diabetes mellitus who died from SCC which developed from an area of NLD present for over 10 years. Currently, there are a paucity of recommendations in the medical literature for screening people with NLD for the early diagnosis of SCC. We believe that clinicians should regard non-healing ulcers in the setting of NLD with a high index of clinical suspicion for SCC, and an early biopsy of such lesions should be recommended.

Learning points:

  • Non-healing, recalcitrant ulcers arising from necrobiosis lipoidica diabeticorum, which fail to heal by conservative measures, should be regarded with a high index of clinical suspicion for malignancy.

  • If squamous cell carcinoma is suspected, a biopsy should be performed as soon as possible to prevent metastatic spread, amputation or even death.

  • Our literature search failed to reveal specific recommendations for screening and follow-up of non-healing recalcitrant ulcers in the setting of necrobiosis lipoidica diabeticorum.

  • Further research is required in this field.

Taxonomy:
Clinical Overview, Gland/Organ, Skin, Topic, Diabetes, Tumours and neoplasia, Hormone, Insulin, Condition/ Syndrome, Diabetes mellitus type 1, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, White, Country of Treatment, United Kingdom, Diagnosis and Treatment, Signs and Symptoms, Back pain, Chronic pain, Diabetes mellitus type 1, Erythema, Fungating lesion, Leg pain, Lymphadenitis, Malaise, Renal insufficiency, Skin necrosis, Weight loss, Investigation, CT scan, Fine needle aspiration biopsy, Haemoglobin A1c, Histopathology, Skin biopsy, Intervention, Amputation, Analgesics, Lymph node dissection, Radiotherapy, Medication, Corticosteroids, Insulin, Related Disciplines, Nursing, Podiatry, Surgery, Publication Details, Case Report Type, Error in diagnosis/pitfalls and caveats
DOI:
https://doi.org/10.1530/EDM-19-0007
Volume/Issue:
Volume 2019: Issue 1
Open access
Alessandro Mantovani Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Alessandro Mantovani in
Google Scholar
PubMed Close
,
Maddalena Trombetta Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Maddalena Trombetta in
Google Scholar
PubMed Close
,
Chiara Imbriaco Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Chiara Imbriaco in
Google Scholar
PubMed Close
,
Riccardo Rigolon Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Riccardo Rigolon in
Google Scholar
PubMed Close
,
Lucia Mingolla Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Lucia Mingolla in
Google Scholar
PubMed Close
,
Federica Zamboni Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Federica Zamboni in
Google Scholar
PubMed Close
,
Francesca Dal Molin Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Francesca Dal Molin in
Google Scholar
PubMed Close
,
Dario Cioccoloni Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Dario Cioccoloni in
Google Scholar
PubMed Close
,
Viola Sanga Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Viola Sanga 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
,
Enrico Brocco Regional Referral Center for the Treatment of Diabetic Foot, Policlinico Abano Terme, Padova, Italy

Search for other papers by Enrico Brocco in
Google Scholar
PubMed Close
,
Michela Conti Division of Infectious Disease, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Michela Conti in
Google Scholar
PubMed Close
,
Giorgio Ravenna Division of Neurosurgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrataof Verona, Verona, Italy

Search for other papers by Giorgio Ravenna in
Google Scholar
PubMed Close
,
Fabrizia Perrone Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Fabrizia Perrone in
Google Scholar
PubMed Close
,
Vincenzo Stoico Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Vincenzo Stoico in
Google Scholar
PubMed Close
, and
Enzo Bonora Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Enzo Bonora in
Google Scholar
PubMed Close

Summary

Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a ‘possible’ diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain.

Learning points

  • Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes.

  • The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access.

  • Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot.

  • Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a “possible” diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain.

  • Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes.

Taxonomy:
Clinical Overview, Gland/Organ, Bone, Topic, Diabetes, Hormone, Insulin, Procalcitonin, Condition/ Syndrome, Abscess, Diabetes mellitus type 2, Diabetic foot syndrome, Osteomyelitis, Patient Demographics, Age, Adolescent/young adult, Gender, Male, Ethnicity, White, Country of Treatment, Italy, Diagnosis and Treatment, Signs and Symptoms, Back pain, Diabetic foot ulceration, Erythema, Infections, Inflexibility, Oedema, Pyrexia, Investigation, Bone biopsy, C-reactive protein, Creatinine (serum), Glucose (blood, fasting), Haemoglobin, Haemoglobin A1c, MRI, Platelet count, Procalcitonin, White blood cell differential count, Intervention, Debridement, Medication, Amoxicillin, Antibiotics, Antiseptic, Related Disciplines, Podiatry, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-15-0132
Volume/Issue:
Volume 2016: Issue 1
Open access