Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a disorder marked by limited joint movement and features resembling scleroderma. Scleroderma-like skin changes are frequently linked to uncontrolled diabetes, in contrast to limited scleroderma, which typically manifests with a prior history of Raynaud’s phenomenon. This underscores the fact that scleroderma-like is often underdiagnosed and can mimic both autoimmune and microvascular disorders.

In this report, we presented a case of a 58-year-old diabetic female with a 1-year history of gradual stiffening of the fingers with frequent episodes of white-blue discoloration. Physical examination revealed multiple ulcers on sausage-shaped fingers, erythematous thick plaques topped with crust on the palms with associated induration, thickening, and a positive prayer sign. Biopsy of the palms and digits shows thickened collagen bundles in the superficial to deep dermis. Alcian blue was positive. Blood chemistry showed elevated glycosylated hemoglobin and fasting glucose. Immunoassays were negative for ANA, RF, anti-dsDNA, anti-RNP, anti-SM, anti-SSA, SCL70, and anti-CENP. Treatment with potent corticosteroid twice daily was started concurrently with the initiation of insulin by the endocrinologist.

Our case highlights the importance of early recognition of scleroderma-like cutaneous manifestations, whose close relationship to diabetes mellitus affects its overall morbidity. Prompt screening for endocrinopathy will help in early treatment initiation and prevent further complications.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Diabetes Mellitus

After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

Human ; Male ; Aged: 65-79 Yrs Old ; Arthritis ; Rheumatology

Congenital syphilis is a worldwide public health concern. This occurs when an infected mother transmits the infection to the fetus during pregnancy or at birth.

We present a case of a 6-day-old male, term, born to a mother with secondary syphilis, via normal spontaneous delivery. Upon birth, patient was well and not in cardiorespiratory distress. However, cutaneous examination revealed multiple, well-defined vesicles and pustules on an erythematous background, some topped with erosions and crusts on the scalp, face, extremities, and trunk. Laboratory work-up and imaging were done which revealed congenital syphilis. He was managed with intravenous Penicillin (100,000iu) 160,000 IV for ten days, and wound healing was hastened by use of a coconut-based cellulose wound dressing on the erosions. He was then referred to a multispecialty team to assess and co-manage possible complications. Regular interval follow-up and repeat laboratory tests were advised for observation and for monitoring.

Congenital syphilis is caused by the bacterium Treponema pallidum. Sequelae include preterm birth, low birth weight, skin lesions, bone deformities, hepatosplenomegaly, anemia, and neurological problems. Diagnosis can be made on clinical suspicion combined with Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL). Aside from Penicillin G, wound care, nutritional build up, and close monitoring of growth and development with regular follow-ups are essential aspects in the management of congenital syphilis. With timely and adequate treatment, infants have a higher likelihood of complete resolution of symptoms, prevention of long-term complications, and improved overall health outcomes.

Human ; Male ; Infant Newborn: First 28 Days After Birth ; Syphilis, Congenital ; Syphilis