Browse

You are looking at 1 - 10 of 14 items

Anna Luiza Galeazzi Rech Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland

Search for other papers by Anna Luiza Galeazzi Rech in
Google Scholar
PubMed
Close
,
Yvon Stüve Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland

Search for other papers by Yvon Stüve in
Google Scholar
PubMed
Close
,
Andreas Toepfer Kantonsspital Sankt Gallen, Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparts, Sankt Gallen, Switzerland

Search for other papers by Andreas Toepfer in
Google Scholar
PubMed
Close
, and
Katrin E Schimke Kantonsspital Sankt Gallen, Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland

Search for other papers by Katrin E Schimke in
Google Scholar
PubMed
Close

Summary

Acute Charcot neuropathic osteoarthropathy (CN) is a clinical entity which can easily go unrecognized in its acute early stages due to lack of awareness and unspecific presentation. However, missing early diagnosis can lead to severe complications. We present the case of a 72-year-old male patient who went through the natural course of the disease unnoticed before the very eyes of his physicians leading to a tragic end. We aim to raise awareness for this rare diabetic complication, emphasizing the necessity of early diagnosis and adequate, interdisciplinary treatment.

Learning points:

  • Clinical signs and symptoms of acute Charcot neuropathic osteoarthropathy (CN).

  • Red flags.

  • Importance of early diagnosis and correct treatment.

  • Diagnostic challenges of acute CN.

  • Awareness of high morbidity and mortality.

Open access
N Siddique Departments of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Royal College of Surgeons in Ireland, Dublin, Ireland

Search for other papers by N Siddique in
Google Scholar
PubMed
Close
,
R Durcan Departments of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Royal College of Surgeons in Ireland, Dublin, Ireland

Search for other papers by R Durcan in
Google Scholar
PubMed
Close
,
S Smyth Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland

Search for other papers by S Smyth in
Google Scholar
PubMed
Close
,
T Kyaw Tun Departments of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Royal College of Surgeons in Ireland, Dublin, Ireland

Search for other papers by T Kyaw Tun in
Google Scholar
PubMed
Close
,
S Sreenan Departments of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Royal College of Surgeons in Ireland, Dublin, Ireland

Search for other papers by S Sreenan in
Google Scholar
PubMed
Close
, and
J H McDermott Departments of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Royal College of Surgeons in Ireland, Dublin, Ireland

Search for other papers by J H McDermott in
Google Scholar
PubMed
Close

Summary

We present three cases of acute diabetic neuropathy and highlight a potentially underappreciated link between tightening of glycaemic control and acute neuropathies in patients with diabetes. Case 1: A 56-year-old male with poorly controlled type 2 diabetes (T2DM) was commenced on basal-bolus insulin. He presented 6 weeks later with a diffuse painful sensory neuropathy and postural hypotension. He was diagnosed with treatment-induced neuropathy (TIN, insulin neuritis) and obtained symptomatic relief from pregabalin. Case 2: A 67-year-old male with T2DM and chronic hyperglycaemia presented with left lower limb pain, weakness and weight loss shortly after achieving target glycaemia with oral anti-hyperglycaemics. Neurological examination and neuro-electrophysiological studies suggested diabetic lumbosacral radiculo-plexus neuropathy (DLPRN, diabetic amyotrophy). Pain and weakness resolved over time. Case 3: A 58-year-old male was admitted with blurred vision diplopia and complete ptosis of the right eye, with intact pupillary reflexes, shortly after intensification of glucose-lowering treatment with an SGLT2 inhibitor as adjunct to metformin. He was diagnosed with a pupil-sparing third nerve palsy secondary to diabetic mononeuritis which improved over time. While all three acute neuropathies have been previously well described, all are rare and require a high index of clinical suspicion as they are essentially a diagnosis of exclusion. Interestingly, all three of our cases are linked by the development of acute neuropathy following a significant improvement in glycaemic control. This phenomenon is well described in TIN, but not previously highlighted in other acute neuropathies.

Learning points:

  • A link between acute tightening of glycaemic control and acute neuropathies has not been well described in literature.

  • Clinicians caring for patients with diabetes who develop otherwise unexplained neurologic symptoms following a tightening of glycaemic control should consider the possibility of an acute diabetic neuropathy.

  • Early recognition of these neuropathies can obviate the need for detailed and expensive investigations and allow for early institution of appropriate pain-relieving medications.

Open access
Yasuhiro Oda Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Yasuhiro Oda in
Google Scholar
PubMed
Close
,
Masayuki Yamanouchi Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Masayuki Yamanouchi in
Google Scholar
PubMed
Close
,
Hiroki Mizuno Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Hiroki Mizuno in
Google Scholar
PubMed
Close
,
Rikako Hiramatsu Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Rikako Hiramatsu in
Google Scholar
PubMed
Close
,
Tatsuya Suwabe Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Tatsuya Suwabe in
Google Scholar
PubMed
Close
,
Junichi Hoshino Nephrology Center, Toranomon Hospital, Tokyo, Japan
Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

Search for other papers by Junichi Hoshino in
Google Scholar
PubMed
Close
,
Naoki Sawa Nephrology Center, Toranomon Hospital, Tokyo, Japan

Search for other papers by Naoki Sawa in
Google Scholar
PubMed
Close
,
Kenichi Ohashi Department of Pathology, Toranomon Hospital, Tokyo, Japan
Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

Search for other papers by Kenichi Ohashi in
Google Scholar
PubMed
Close
,
Takeshi Fujii Department of Pathology, Toranomon Hospital, Tokyo, Japan

Search for other papers by Takeshi Fujii in
Google Scholar
PubMed
Close
, and
Yoshifumi Ubara Nephrology Center, Toranomon Hospital, Tokyo, Japan
Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

Search for other papers by Yoshifumi Ubara in
Google Scholar
PubMed
Close

Summary

We report the renal histology of a 66-year-old man with hypertension, cardiovascular disease, and a 30-year history of type 2 diabetes mellitus with proliferative diabetic retinopathy, diabetic neuropathy, and diabetic foot status post toe amputation. Urinary protein excretion was 1.4 g/gCr, serum creatinine level 0.86 mg/dL, estimated glomerular filtration rate 69 mL/min/1.73 m2, and HbA1c 13–15%, despite using insulin. Light microscopy showed global glomerulosclerosis in 37% of the glomeruli, but the remaining glomeruli were intact. Significant polar vasculosis was present, while arteriolar sclerosis was mild. Electron microscopy revealed a thickened glomerular basement membrane, which is compatible with the early stage of diabetic glomerulopathy. The presented case was unique because glomerular changes seen typically in diabetes were not seen in the patient, despite the long-standing history of diabetes and diabetic comorbidities, while prominent polar vasculosis was found. Polar vascular formation helps preserve the glomeruli by allowing hyperosmotic blood bypass the glomeruli; this decreases intraglomerular pressure and minimizes glomerular endothelial damage.

Learning points:

  • A 66-year-old man with a 30-year history of type 2 diabetes mellitus with poor glycemic control underwent renal biopsy, which showed scarce glomerular changes typically seen in diabetic kidney disease and instead revealed significant polar vasculosis.

  • Past studies demonstrated that the increased small vessels around the vascular hilus in diabetic patients originated from the afferent arterioles and drained into the peritubular capillaries.

  • Polar vascular formation may preserve glomerular function by allowing the blood flow to bypass the glomeruli and decreasing the intraglomerular pressure, which minimizes endothelial damage of the glomerular tufts.

Open access
Joanna Prokop Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Joanna Prokop in
Google Scholar
PubMed
Close
,
João Estorninho Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by João Estorninho in
Google Scholar
PubMed
Close
,
Sara Marote Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Sara Marote in
Google Scholar
PubMed
Close
,
Teresa Sabino Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Teresa Sabino in
Google Scholar
PubMed
Close
,
Aida Botelho de Sousa Departments of Hemato-Oncology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Aida Botelho de Sousa in
Google Scholar
PubMed
Close
,
Eduardo Silva Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Eduardo Silva in
Google Scholar
PubMed
Close
, and
Ana Agapito Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Search for other papers by Ana Agapito in
Google Scholar
PubMed
Close

Summary

POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) is a rare multisystemic disease. Clinical presentation is variable, the only mandatory criteria being polyneuropathy and monoclonal gammapathy in association with one major and one minor criterion. Primary adrenal insufficiency is rarely reported. We describe a case of a 33-year-old patient, in whom the presenting symptoms were mandibular mass, chronic sensory-motor peripheral polyneuropathy and adrenal insufficiency. The laboratory evaluation revealed thrombocytosis, severe hyperkalemia with normal renal function, normal protein electrophoresis and negative serum immunofixation for monoclonal protein. Endocrinologic laboratory work-up confirmed Addison’s disease and revealed subclinical primary hypothyroidism. Thoracic abdominal CT showed hepatosplenomegaly, multiple sclerotic lesions in thoracic vertebra and ribs. The histopathologic examination of the mandibular mass was nondiagnostic. Bone marrow biopsy revealed plasma cell dyscrasia and confirmed POEMS syndrome. Axillary lymphadenopathy biopsy: Castleman’s disease. Gluco-mineralocorticoid substitution and levothyroxine therapy were started with clinical improvement. Autologous hematopoietic cell transplantation (HCT) was planned, cyclophosphamide induction was started. Meanwhile the patient suffered two ischemic strokes which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of two cerebral arteries. The patient deceased 14 months after the diagnosis. The young age at presentation, multiplicity of manifestations and difficulties in investigation along with the absence of serum monoclonal protein made the diagnosis challenging. We report this case to highlight the need to consider POEMS syndrome in differential diagnosis of peripheral neuropathy in association with endocrine abnormalities even in young patients.

Learning points:

  • POEMS syndrome is considered a ‘low tumor burden disease’ and the monoclonal protein in 15% of cases is not found by immunofixation.

  • Neuropathy is the dominant characteristic of POEMS syndrome and it is peripheral, ascending, symmetric and affecting both sensation and motor function.

  • Endocrinopathies are a frequent feature of POEMS syndrome, but the cause is unknown.

  • The most common endocrinopathies are hypogonadism, primary hypothyroidism and abnormalities in glucose metabolism.

  • There is no standard therapy; however, patients with disseminated bone marrow involvement are treated with chemotherapy with or without HCT.

Open access
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 (). The lesions are often yellow or brown with telangiectatic plaque, a central area of atrophy and raised violaceous borders (). 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 (). A number of cases of SCC from NLD have been recorded (, , ); 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.

Open access
Maria P Yavropoulou Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece

Search for other papers by Maria P Yavropoulou in
Google Scholar
PubMed
Close
,
Christos Poulios Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece

Search for other papers by Christos Poulios in
Google Scholar
PubMed
Close
,
Christoforos Foroulis Department of Thoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece

Search for other papers by Christoforos Foroulis in
Google Scholar
PubMed
Close
,
Symeon Tournis Laboratory of Research of Musculoskeletal System ‘Th. Garofalidis’, KAT Hospital University of Athens, Greece

Search for other papers by Symeon Tournis in
Google Scholar
PubMed
Close
,
Prodromos Hytiroglou Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece

Search for other papers by Prodromos Hytiroglou in
Google Scholar
PubMed
Close
,
Kalliopi Kotsa Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece

Search for other papers by Kalliopi Kotsa in
Google Scholar
PubMed
Close
,
Isaak Kessisoglou 3rd Department of Surgery, AHEPA University Hospital, Thessaloniki, Greece

Search for other papers by Isaak Kessisoglou in
Google Scholar
PubMed
Close
, and
Pantelis Zebekakis Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece

Search for other papers by Pantelis Zebekakis in
Google Scholar
PubMed
Close

Summary

Tumor-induced osteomalacia (TIO) is a rare form of hypophosphatemia usually caused by phosphaturic mesenchymal tumors (PMTs); the biologic behavior of PMTs is under investigation. Herein we present a case of TIO with a protracted course over 12 years leading to a fatal outcome. A 39-year-old man presented with weakness in 2004 and was found to have decreased serum phosphorus, phosphaturia and low levels of 1,25-dihydroxyvitamin D3. Four years later he developed a painful left calf mass. The lesion was resected, but recurred causing extreme pain and dysfunction. Radiological examination showed a large cluster of soft tissue tumors affecting all the muscle compartments of the calf and a smaller lesion inside the metaphysis of the tibia. Above-knee amputation was performed. Histological examination of all lesions showed a cellular spindle cell neoplasm with variously sized vessels, wide vessel-like spaces and scattered deposits of calcified extracellular material. The tumor infiltrated skeletal muscles, subcutaneous fat and the proximal end of the fibula. The tibial lesion had identical histology. Three years after the amputation the patient presented with cough and dyspnea. Radiological examination, followed by an open biopsy, showed that there were multiple metastatic nodules of PMTs in both lungs. Shortly after the diagnosis the patient died. This case illustrates that even benign cases of PMTs may lead to a fatal outcome and the classification of PMTs into benign and malignant should be reassessed in order to correspond to its biological behavior.

Learning points:

  • PMTs, aside from having locally aggressive behavior, may metastasize and cause death

  • PMTs may behave aggressively despite ‘benign’ histological findings

  • Accurate diagnosis of tumor-induced osteomalacia and patient management require a multidisciplinary approach

Open access
Snezana Burmazovic Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

Search for other papers by Snezana Burmazovic in
Google Scholar
PubMed
Close
,
Christoph Henzen Department of Internal Medicine and Endocrinology, Lucerne Cantonal Hospital, Lucerne, Switzerland

Search for other papers by Christoph Henzen in
Google Scholar
PubMed
Close
,
Lukas Brander Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

Search for other papers by Lukas Brander in
Google Scholar
PubMed
Close
, and
Luca Cioccari Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, Australia

Search for other papers by Luca Cioccari in
Google Scholar
PubMed
Close

Summary

The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus. We report a rare case of concurrent manifestation of hyperosmolar hyperglycaemic state and central diabetes insipidus in a patient with a history of craniopharyngioma.

Learning points:

  • In patients with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology to be considered.

  • However, a history of craniopharyngioma, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and osmolality provide evidence of concurrent diabetes insipidus.

  • Therefore, if a patient with diabetes mellitus presents with severe hypernatraemia, hyperglycaemia, a low or low normal urinary-specific gravity and worsening polyuria despite correction of hyperglycaemia, concurrent diabetes insipidus should be sought.

Open access
Syed Ali Imran Division of Endocrinology and Metabolism, Dalhousie University, Halifax, Nova Scotia, Canada

Search for other papers by Syed Ali Imran in
Google Scholar
PubMed
Close
,
Khaled A Aldahmani Division of Endocrinology, Tawam Hospial, Al-Ain, UAE

Search for other papers by Khaled A Aldahmani in
Google Scholar
PubMed
Close
,
Lynette Penney Department of Pediatrics, Tawam Hospial, Al-Ain, UAE

Search for other papers by Lynette Penney in
Google Scholar
PubMed
Close
,
Sidney E Croul Department of Pathology, Tawam Hospial, Al-Ain, UAE

Search for other papers by Sidney E Croul in
Google Scholar
PubMed
Close
,
David B Clarke Department of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada

Search for other papers by David B Clarke in
Google Scholar
PubMed
Close
,
David M Collier Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK

Search for other papers by David M Collier in
Google Scholar
PubMed
Close
,
Donato Iacovazzo Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK

Search for other papers by Donato Iacovazzo in
Google Scholar
PubMed
Close
, and
Márta Korbonits Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK

Search for other papers by Márta Korbonits in
Google Scholar
PubMed
Close

Summary

Early-onset acromegaly causing gigantism is often associated with aryl-hydrocarbon-interacting receptor protein (AIP) mutation, especially if there is a positive family history. A15y male presented with tiredness and visual problems. He was 201 cm tall with a span of 217 cm. He had typical facial features of acromegaly, elevated IGF-1, secondary hypogonadism and a large macroadenoma. His paternal aunt had a history of acromegaly presenting at the age of 35 years. Following transsphenoidal surgery, his IGF-1 normalized and clinical symptoms improved. He was found to have a novel AIP mutation destroying the stop codon c.991T>C; p.*331R. Unexpectedly, his father and paternal aunt were negative for this mutation while his mother and older sister were unaffected carriers, suggesting that his aunt represents a phenocopy.

Learning points:

  • Typical presentation for a patient with AIP mutation with excess growth and eunuchoid proportions.

  • Unusual, previously not described AIP variant with loss of the stop codon.

  • Phenocopy may occur in families with a disease-causing germline mutation.

Open access
Alessandro Mantovani Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

Search for other papers by Alessandro Mantovani 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
,
Vincenzo Stoico Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

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

Search for other papers by Isabella Pichiri in
Google Scholar
PubMed
Close
,
Laura Salvotelli Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

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

Search for other papers by Ilaria Teobaldi in
Google Scholar
PubMed
Close
,
Massimiliano Bruti Division of Plastic Surgery, Department of Surgery

Search for other papers by Massimiliano Bruti in
Google Scholar
PubMed
Close
,
Michela Conti Division of Infectious Disease, Department of Medicine and

Search for other papers by Michela Conti in
Google Scholar
PubMed
Close
,
Luca Cima Division of Pathology Unit, Department of Diagnostics and Public Health, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

Search for other papers by Luca Cima in
Google Scholar
PubMed
Close
,
Albino Eccher Division of Pathology Unit, Department of Diagnostics and Public Health, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

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

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

Summary

The incidences of type 2 diabetes mellitus and many cancers are rapidly increasing worldwide. Diabetes is a strong risk factor for some cancers (including lymphomas) and is also associated with adverse cancer outcomes. After gastrointestinal tract, the skin is the second most frequent extranodal site involved by non-Hodgkin lymphomas and the cutaneous B-cell lymphomas (CBCLs) range from 25% to 30% of all primary cutaneous lymphomas. The primary cutaneous diffuse large B-cell lymphoma (PCDLBCL) is an aggressive lymphoma with a poor prognosis, representing roughly 20% of all primary CBCLs. Classically, the cutaneous manifestation of this lymphoma is a red or violaceous tumors arising on a leg. To date, despite the large body of evidence suggesting that diabetes is strongly associated with an increased risk of some cancers, very little information is available regarding a possible association between type 2 diabetes and primary cutaneous diffuse large B-cell lymphoma. In this report, we will present the case of a white adult patient with type 2 diabetes with chronic leg ulcers complicated by a primary cutaneous diffuse large B-cell lymphoma.

Learning points:

  • Diabetes mellitus is increasing worldwide as well as the incidence of many cancers.

  • Diabetes mellitus is a powerful risk factor for some cancers (including lymphomas) and is strongly associated with adverse cancer outcomes.

  • Seen that diabetes is strongly associated with an increased risk of cancers (including cutaneous lymphomas), clinicians should always keep in mind this complication in elderly patients with type 2 diabetes, even in a chronic leg ulcer with hypertrophy of the wound edge, which is hard to heal and does not have the typical characteristics of a diabetic or vascular ulcer. In these cases, a biopsy should be performed to rule out a neoplasm.

  • Early diagnosis and correct management of cancer in a patient with type 2 diabetes are crucial to improve clinical outcomes.

Open access
Davi da Silva Barbirato Wolfgang C. Pfeiffer Laboratory of Environmental Biogeochemistry, Federal University of Rondônia (UNIR), Rio de Janeiro, Brazil

Search for other papers by Davi da Silva Barbirato in
Google Scholar
PubMed
Close
,
Mariana Fampa Fogacci Wolfgang C. Pfeiffer Laboratory of Environmental Biogeochemistry, Federal University of Rondônia (UNIR), Rio de Janeiro, Brazil

Search for other papers by Mariana Fampa Fogacci in
Google Scholar
PubMed
Close
,
Mariana Arruda Department of Internal Medicine and Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Search for other papers by Mariana Arruda in
Google Scholar
PubMed
Close
,
Monique Oliveira Rodrigues Division of Graduate Periodontics, Department of Dental Clinic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Faculdades São José, Rio de Janeiro, Brazil

Search for other papers by Monique Oliveira Rodrigues in
Google Scholar
PubMed
Close
, and
Leonardo Vieira Neto Department of Internal Medicine and Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Search for other papers by Leonardo Vieira Neto in
Google Scholar
PubMed
Close

Summary

Osteopetrosis (OP) comprehends a rare group of conditions, presenting on radiographs increased bone density, deriving from irregularities in osteoclast differentiation or function. In the autosomal dominant osteopetrosis (ADO), some patients stay asymptomatic for some time, or only develop mild symptoms. The dental surgeon is often the first to presuppose the disease during routine imaging examinations, referring the patient to a specialized medical group. Furthermore, osteomyelitis is one of the major OP complications, and should be refrained through frequent dental monitoring. Signals of cortical interruption, sclerotic sequestra or periosteal new bone formation, should be looked for in these patients. Their dental management is complex and procedures encompassing bone tissue, such as implant procedures, tissue regenerations, tooth extractions, maxillofacial surgeries and orthodontic treatments, when elected, should be avoided. This case report describes a case of ADO with a diagnosis of moderate generalized chronic periodontitis, not statistically related to plaque index. This is the first case to describe such a condition, in which the systemic component and the altered bone metabolism seem to be related to the loss of periodontal apparatus, independent of the biofilm. Concerning prevention, we can reinforce the need for frequent dental monitoring to avoid further interventions in those cases.

Learning points:

  • This paper reports a case in which the systemic component and the altered bone metabolism seem to have been related to the loss of periodontal attachment apparatus, independent of the biofilm.

  • The periodontal damage observed in the OP patient was not related to the dental plaque, which leads us to suggest that the cases of periodontitis in OP patients should be diagnosed as periodontitis as a manifestation of systemic diseases.

  • The periodontitis prevention should be longed for in OP patients thus, we propose that doctors responsible for patients with OP refer them to a dental service as soon as possible and that dentists should be aware of the preventive dentistry value as well as the most appropriate dental management for those cases.

Open access