Unrecognised Peripheral Neuropathy and Septic Hand Ulcer as First Presentation of Diabetes Mellitus in a Nigerian Woman. A Case Report and Literature Review

Abstract

Diabetes mellitus may for the first time present with its classical features or with long term complications which may or may not be recognised. Knowledge of diabetes mellitus and its complications, sociocultural beliefs and perception, patronage of traditional healers may influence time of presentation and hence, outcomes. We report the case of a female Nigerian food vendor, who was admitted in coma and managed for septic left-hand ulcer and incidental diabetes mellitus. She had painless peripheral neuropathy, which gave her the ''ability'' to handle hot objects. This was misconstrued as some special gift derived from a benevolent spirit, until she sustained thermal injury and a non-healing wound on her left hand. She presented to a traditional healer which delayed hospital presentation. She was eventually brought to hospital in coma and related diabetes mellitus was found. She was appropriately managed for hyperglycaemic coma and sepsis as well as wound care and was discharged to the out patients' services on appropriate drugs and life style measures.

Keywords: Diabetes Mellitus; Hand; Infection; Peripheral Neuropathy; Unrecognised.

Figure 1a and b:

Shows left hand with a linear left palmer ulcer with a scab and deep abscess involving the little finger (1a), as well as swelling of the dorsum and desquamation of the skin (1b).

Figures 2a and b:

Show post healing deformity of the little finger as viewed from the dorsal and plantar surfaces respectively.