Endocrine Abstracts

Background: Diabetic foot infections are an important cause of morbidity and mortality associated with poor glycemic control, polyneuropathy and micro/macrovascular diseases. The clinical, laboratory, radiological, pharmacological and/or surgical evaluation is required. We report a case of diabetic foot infection with bilaterally charcot joint.

Case: A 52-year-old female patient with type 2 diabetes mellitus (DM), hypertension (HT), coronary artery disease (CAD) and peripheral artery disease (PAD) applied to our endocrine clinic with ulcerated lesion on the sole of the right foot. Eight years previously she had undergone a left first metatarsophalangeal (MTP) joint amputation due to underlying diabetic foot. On examination, she had a bilaterally neuropathic arthropathy (Charcot joint). Her plasma glucose level was 272 mg/dl, HbA1C of%7.8, erythrocyte sedimentation rate (ESR) of 46 mm/h and C-reactive protein (CRP) of 41.2 (normal range, 0-5) mg/l with normal renal and liver function tests in the first laboratory evaluation. Two-sided X-Ray and magnetic resonance imaging (MRI) of the ankle and foot revealed destructive joint disease without osteomyelitis (Figure 1). The diagnosis of diabetic foot infection was made, and treatment with intravenous piperacillin/tazobactam and teicoplanin for two weeks, then the patient improved. After clinical and biochemical improvements, the patient was discharged with oral antibiotics.

Discussion: Uncontrolled diabetes mellitus is the most common cause of non-traumatic amputations. Chronic, progressive and destructive arthropathy may develop in diabetic patients associated with sensory, autonomic and motor neuropathy. Treatment of charcot neuroarthropathy is based on multidiciplinary team management. Inappropriate and late approach of diabetic foot infection often results to amputation of any limb.