Skip to main content Skip to main navigation menu Skip to site footer

Case report of a person with diabetes mellitus who has tropical diabetic hand syndrome

  • Miftahani Leo Choirunnisa ,
  • Rio Wironegoro ,


-Introduction: Diabetes mellitus (DM) is a chronic systemic disease that causes morbidity and mortality. Diabetes often increases the incidence and severity of various infections, especially those caused by bacteria and fungi, where patients have hyperglycemia and poor blood sugar control. Tropical diabetic hand syndrome (TDHS) is a specific hand complication experienced by people with DM in tropical countries. The syndrome involves localized cellulitis, which can be progressive and fulminant to hand sepsis and gangrene. Management of patients with TDHS requires a comprehensive strategy and management to reduce mortality and morbidity. This study aimed to report a rare case of a patient with T2DM who experienced TDHS.

Case Presentation: A 45-year-old man came to the emergency department of RSUD Dr. Soetomo, with a chief complaint of a wound on his right hand caused by a rusty nail that had not healed for three days. The patient said that he had uncontrolled DM for six years. In manus dextra examination, an ulcer measuring 0.5x 0.5 cm was found on the back of the hand on the ulnar side, with edema, hyperemia, and active pus discharge. The patient was hospitalized for nine days and discharged when the complaints and the blood sugar level were improved. On the seventh day after discharge, the complaints felt significantly reduced, the wound improved with granulation tissue appearing, and the blood sugar level was within normal limits. The patient was given insulin aspart injection of 10 units thrice daily, basal insulin of 16 units, ciprofloxacin 500 mg twice daily, ibuprofen 400 mg thrice daily, and cilostazol 100 mg twice daily.

Conclusion: In this case report, we presented a case of a 45-year-old man with manifestations of TDHS as a complication of uncontrolled DM for six years and delay in obtaining medical services. Management of patients with TDHS includes hospitalization, elevation of the affected hand, optimal blood sugar control, administration of antibiotics, and wound care. Education for T2DM complications remains the most important preventive measure in developing countries.


  1. Salih MA, Mahmoud SM, Ahmed ME. Patterns of finger sepsis and predictors of its outcome in patients with diabetic septic hand. Int J Diabetes Dev Ctries. 2018;38(3):338–44.
  2. Dwipayanti NMA, Nariata IW, Aryana IGPS. Diabetes mellitus control among elderly patients at geriatric polyclinic of Karangasem District Hospital, Bali, Indonesia: a preliminary study. Bali Medical Journal. 2020;9(1):279–85.
  3. van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol. 2017;5(6):457–68.
  4. Christanti M, Prajitno JH, Christanto RY. A patient with Type 2 Diabetes Mellitus (T2DM) with Fournier gangrene: a case report. Bali Medical Journal. 2022;11(1):61–6.
  5. Akhuemokhan K, Echekwube P, Bakpa F, Okokhere P. Tropical diabetic hand syndrome: prevention through education. South African Journal of Clinical Nutrition. 2011;24(4):205–6.
  6. Abbas ZG, Archibald LK. Tropical Diabetic Hand Syndrome. Am J Clin Dermatol. 2005;6(1):21–8.
  7. Kasim KM, Bujang MA, Abdullah MAH, Huan PC, Johari J, Ponniah JPS, et al. Characteristics and outcome of patients with hand and upper limb infection in a diabetes patients. Int J Diabetes Dev Ctries. 2015;35(2):123–8.
  8. Wang C, Lv L, Wen X, Chen D, Cen S, Huang H, et al. A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centre. Diabetic Medicine. 2010;27(7):848–51.
  9. Ewezu Ngim N, Amah P, Abang I. Tropical Diabetic Hand Syndrome: report of 2 cases. Pan Afr Med J. 2012;12:24.
  10. PERKENI. Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Di Indonesia. Jakarta: PERKENI; 2021.
  11. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461–98.
  12. Powers A. Diabetes Melitus: Complication. In: Kasper D, Longo D, Hauser S, Jameson J, Fauci A, Localso J, editors. Harrisons Principle's Of Internal Medicine. 19th Ed. New York: McGraw Hill Medical; 2016. p. 2422–30.
  13. Okpara T, Ezeala-Adikaibe B, Omire O, Nwonye E, Maluze J. Tropical diabetic hand syndrome. Ann Med Health Sci Res. 2015;5(6):473.
  14. Zyluk A, Puchalski P. Hand disorders associated with diabetes: a review. Acta Orthop Belg. 2015;81(2):191–6.
  15. Schmidt G, Piponov H, Chuang D, Gonzalez M. Hand Infections in the Immunocompromised Patient: An Update. J Hand Surg Am. 2019;44(2):144–9.
  16. Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. International Journal of Infectious Diseases. 2006;10(4):315–9.
  17. Papanas N, Maltezos E. The diabetic hand: a forgotten complication? J Diabetes Complications. 2010;24(3):154–62.
  18. AYDIN F. Diabetic hand infections and hyperbaric oxygen therapy. Acta Orthop Traumatol Turc. 2014;48(6):649–54.
  19. PERKENI. Petunjuk praktis Terapi Insulin pada pasien Diabetes Melitus. Jakarta: PERKENI; 2021.
  20. Pranoto A, Prajitno J. Terapi Insulin. In: Tjokroprawiro A, Setiawan P, Effendi C, Santoso D, Soegiarto G, editors. Buku Ajar Ilmu Penyakit Dalam. Surabaya: Airlangga University Press; 2015. p. 108–17.
  21. Efie DT, Yeika EV, Mbassi C, Choukem SP. Tropical Diabetic Hand Syndrome: A Case Report with an Overview of Literature. Journal of Clinical Images and Case Reports. 2017;1(1).
  22. Chauhan A, Sethi N, Tiwari S. Tropical diabetic hand syndrome. Int J Diabetes Dev Ctries. 2008;28(4):130.

How to Cite

Choirunnisa, M. L., & Wironegoro, R. (2023). Case report of a person with diabetes mellitus who has tropical diabetic hand syndrome. Bali Medical Journal, 12(3), 3443–3447.




Search Panel

Miftahani Leo Choirunnisa
Google Scholar
BMJ Journal

Rio Wironegoro
Google Scholar
BMJ Journal