Bush Dylan, Natuzzi Eileen, Koburu Gordon, Bana Maggie, Taki Flins, Melly Augustin
Ministry of Health & Medical Services, Honiara, Solomon Islands.
Solomon Islands Program, Australia & New Zealand Gastroenterology International Training Association, Solomon Islands.
Int J Surg Case Rep. 2023 Apr;105:108042. doi: 10.1016/j.ijscr.2023.108042. Epub 2023 Mar 23.
Tropical diabetic hand syndrome (TDHS) is a rare and often unrecognized complication that can lead to lifelong disability or even death among diabetic patients living in the tropics.
This study reports the case of a 47-year-old male patient in the Solomon Islands who developed TDHS caused by Klebsiella pneumonia. The patient presented with symptoms of localized cellulitis of the fourth digit of the left hand after being discharged 10.5 weeks prior for an infection on the second digit of the left hand. Subsequent physical exams, surgical debridement, and patient monitoring indicated that the cellulitis spread and developed into necrotizing fasciitis. Despite serial surgical debridement and a fasciotomy, as well as administration of antidiabetic agents and antibiotics, the patient developed sepsis and died forty-five days post-admission.
Medication shortages, late presentation, and failure to pursue aggressive surgery increases risk of TDHS patient morbidity and mortality.
TDHS requires early detection and presentation, aggressive surgical management, and efficient administration of antidiabetic agents and intravenous antibiotics.
热带糖尿病手综合征（TDHS）是一种罕见且常未被识别的并发症，可导致生活在热带地区的糖尿病患者终身残疾甚至死亡。
本研究报告了所罗门群岛一名47岁男性患者的病例，该患者因肺炎克雷伯菌感染引发了TDHS。该患者在10.5周前因左手第二指感染出院后，出现左手第四指局部蜂窝织炎症状。随后的体格检查、手术清创和患者监测表明，蜂窝织炎扩散并发展为坏死性筋膜炎。尽管进行了多次手术清创和筋膜切开术，以及给予抗糖尿病药物和抗生素治疗，但患者仍发生败血症，并在入院后45天死亡。
药物短缺、就诊延迟以及未采取积极手术治疗增加了TDHS患者发病和死亡的风险。
TDHS需要早期发现并就诊、积极的手术治疗以及有效使用抗糖尿病药物和静脉注射抗生素。
