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      Missing the boat: fatal ending to a missed case of Charcot arthropathy

      research-article
      Author(s): 1 , 1 , 2 , 3
      Publication date (Electronic):
      Journal: Endocrinology, Diabetes & Metabolism Case Reports
      Publisher: Bioscientifica Ltd
      Keywords: Geriatric, Male, White, Switzerland, Bone, Bone, Insulin, Charcot neuropathic osteopathy*, Diabetes mellitus type 2, Diabetic foot syndrome, Leg pain, Feet - pain, Feet - increased size, Erythema, Hyperthermia, Oedema, Pallanaesthesia*, Nephropathy , Ankle brachial index*, Monofilament test*, C-reactive protein, White blood cell count, Haemoglobin A1c, Estimated glomerular filtration rate, Skin biopsy, MRI, X-ray, Brain natriuretic peptide, Angiography, Angioplasty, Amputation, Amoxicillin, Clavulanic acid*, Piperacillin*, Tazobactam*, Diuretics, Cefazolin*, Geriatrics, Podiatry, Radiology/Rheumatology, Error in diagnosis/pitfalls and caveats, June, 2020

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          Abstract

          Summary

          Acute Charcot neuropathic osteoarthropathy (CN) is a clinical entity which can easily go unrecognized in its acute early stages due to lack of awareness and unspecific presentation. However, missing early diagnosis can lead to severe complications. We present the case of a 72-year-old male patient who went through the natural course of the disease unnoticed before the very eyes of his physicians leading to a tragic end. We aim to raise awareness for this rare diabetic complication, emphasizing the necessity of early diagnosis and adequate, interdisciplinary treatment.

          Learning points:

          • Clinical signs and symptoms of acute Charcot neuropathic osteoarthropathy (CN).

          • Red flags.

          • Importance of early diagnosis and correct treatment.

          • Diagnostic challenges of acute CN.

          • Awareness of high morbidity and mortality.

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          Most cited references12

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          Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update).

          Benjamin A. Lipsky, Éric Senneville, Zulfiqarali G. Abbas … (2020)
          The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.
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            The Charcot Foot in Diabetes

            Lee C Rogers, Robert G. Frykberg, David Armstrong … (2011)
            The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.
            Article 0 comments Cited 105 times – based on 0 reviews     Review now
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              Diagnostic values for skin temperature assessment to detect diabetes-related foot complications.

              Jeff G van Baal, Sicco Bus, Ferdi van der Heijden … (2014)
              Skin temperature assessment is a promising modality for early detection of diabetic foot problems, but its diagnostic value has not been studied. Our aims were to investigate the diagnostic value of different cutoff skin temperature values for detecting diabetes-related foot complications such as ulceration, infection, and Charcot foot and to determine urgency of treatment in case of diagnosed infection or a red-hot swollen foot.
              Article 0 comments Cited 33 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 16 June 2020
                Publication date Collection: 2020
                Volume: 2020
                Electronic Location Identifier: 20-0013
                Affiliations
                [1 ]Kantonsspital Sankt Gallen , Klinik für Allgemeine Innere Medizin/Hausarztmedizin, Sankt Gallen, Switzerland
                [2 ]Kantonsspital Sankt Gallen , Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparts, Sankt Gallen, Switzerland
                [3 ]Kanatonsspital Sankt Gallen , Klinik für Endokrinologie, Diabetologie, Osteologie und Stoffwechselerkrankungen, Sankt Gallen, Switzerland
                Author notes
                Correspondence should be addressed to K E Schimke; Email: katrin.schimke@ 123456hin.ch
                Article
                Publisher ID: EDM200013
                DOI: 10.1530/EDM-20-0013
                PMC ID: 7354711
                PubMed ID: 32554824
                SO-VID: fcd74812-bcc0-407f-b759-7a5fe077b3fd
                Copyright © © 2020 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                Date received : 07 May 2020
                Date accepted : 26 May 2020
                Categories
                Subject: Geriatric
                Subject: Male
                Subject: White
                Subject: Switzerland
                Subject: Bone
                Subject: Bone
                Subject: Insulin
                Subject: Charcot Neuropathic Osteopathy*
                Subject: Diabetes Mellitus Type 2
                Subject: Diabetic Foot Syndrome
                Subject: Leg pain
                Subject: Feet - pain
                Subject: Feet - increased size
                Subject: Erythema
                Subject: Hyperthermia
                Subject: Oedema
                Subject: Pallanaesthesia*
                Subject: Nephropathy
                Subject: Ankle brachial index*
                Subject: Monofilament test*
                Subject: C-reactive protein
                Subject: White blood cell count
                Subject: Haemoglobin A1c
                Subject: Estimated glomerular filtration rate
                Subject: Skin biopsy
                Subject: MRI
                Subject: X-ray
                Subject: Brain natriuretic peptide
                Subject: Angiography
                Subject: Angioplasty
                Subject: Amputation
                Subject: Amoxicillin
                Subject: Clavulanic acid*
                Subject: Piperacillin*
                Subject: Tazobactam*
                Subject: Diuretics
                Subject: Cefazolin*
                Subject: Geriatrics
                Subject: Podiatry
                Subject: Radiology/Rheumatology
                Subject: Error in Diagnosis/Pitfalls and Caveats
                Subject: Error in Diagnosis/Pitfalls and Caveats

                Keywords: geriatric,male,white,switzerland,bone,insulin,charcot neuropathic osteopathy*,diabetes mellitus type 2,diabetic foot syndrome,leg pain,feet - pain,feet - increased size,erythema,hyperthermia,oedema,pallanaesthesia*,nephropathy ,ankle brachial index*,monofilament test*,c-reactive protein,white blood cell count,haemoglobin a1c,estimated glomerular filtration rate,skin biopsy,mri,x-ray,brain natriuretic peptide,angiography,angioplasty,amputation,amoxicillin,clavulanic acid*,piperacillin*,tazobactam*,diuretics,cefazolin*,geriatrics,podiatry,radiology/rheumatology,error in diagnosis/pitfalls and caveats,june,2020
                Data availability:
                Keywords: geriatric, male, white, switzerland, bone, insulin, charcot neuropathic osteopathy*, diabetes mellitus type 2, diabetic foot syndrome, leg pain, feet - pain, feet - increased size, erythema, hyperthermia, oedema, pallanaesthesia*, nephropathy , ankle brachial index*, monofilament test*, c-reactive protein, white blood cell count, haemoglobin a1c, estimated glomerular filtration rate, skin biopsy, mri, x-ray, brain natriuretic peptide, angiography, angioplasty, amputation, amoxicillin, clavulanic acid*, piperacillin*, tazobactam*, diuretics, cefazolin*, geriatrics, podiatry, radiology/rheumatology, error in diagnosis/pitfalls and caveats, june, 2020

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