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| LETTER TO EDITOR |
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| Year : 2018 | Volume
: 9
| Issue : 1 | Page : 36-37 |
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Giant bullosis diabeticorum over charcot knee
Ganesh Singh Dharmshaktu1, Tanuja Pangtey2
1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India
| Date of Web Publication | 2-Apr-2018 |
Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jod.jod_38_17
How to cite this article:
Dharmshaktu GS, Pangtey T. Giant bullosis diabeticorum over charcot knee. J Diabetol 2018;9:36-7 |
Spontaneous, non-inflammatory blisters have also been reported in patients with diabetes and mainly involve lower extremities and are termed bullosis diabeticorum.[1] The lesion is subepidermal and contains clear sterile fluid and usually heals over several weeks. As they are painless and non-pruritic, clinical morbidity is limited but observation for recurrence, chronic ulceration or secondary infection, however, is required.
A 55-year-old female presented with chronic pain and difficulty in ambulation for the last 8 years and increasing in severity with time for the last 2 months. She was known diabetic and on oral hypoglycaemic drugs for the last 10 years. She was undergoing quadriceps strengthening exercises for knee arthritis from a local practitioner. She noticed swelling of the right knee with spontaneous large blisters over the knee since the last night. There was no history of trauma, fever, systemic or localised infection as well as use of any newer drug. The patient could not recollect any frictional insult to the affected skin. There, however, was history of local fomentation with lukewarm water. There was a large blister over right knee region with visibly clear fluid covering area from medial and infrapatellar aspect and another over lateral aspect of the knee [Figure 1]a and [Figure 1]b. All the three blisters, under aseptic precautions, were punctured with hypodermic needle on one side to remove the fluid and dressed as such. The wound and the swelling uneventfully improved over the following week. Fresh blood sugar levels sent along with total and differential counts, C-reactive protein and erythrocyte sedimentation rate over that period was within normal limits. The radiograph of the affected knee showed gross articular damage of the knee consistent with neuropathic arthropathy secondary to chronic diabetes [Figure 1]c and [Figure 1]d. | Figure 1: The giant blisters over the knee soon after the hot fomentation with clear fluid extravasation. (a and b) The radiograph showing severe arthropathy with gross destruction of joint (c)
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The incidence of bullosis diabeticorum in patients with diabetes is reported of about 0.5%.[2] One Indian study approximates its incidence up to 2% in patients with diabetes.[3] No definitive aetiology has been linked to this blistering lesion, but it has been associated with underlying neuropathy, microangiopathy and deranged calcium metabolism.[4] Acral sites such as feet, legs and hand along with males are commonly affected, and no specific tests are diagnostic.[5]
The Charcot's arthropathy is debilitating form of neuropathic joint disorder associated with chronic diabetic status. In modern times, long-standing diabetes mellitus is important disorder with the potential to lead to serious joint involvements in the settings of neuroarthropathy. There is 7.5% chances of patient with long-standing diabetes to develop neuroarthropathy.[6] Knee, being a weight-bearing joint is also involved (6% in a series) though the most common affected regions are foot and ankle joints (64% in series). Giant blister following fomentation, however, is an unreported event, and this short account may thus have an educative potential about this rare potential complication of hot fomentations in cases with diabetic arthropathy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Lipsky BA, Baker PD, Ahroni JH. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder. Int J Dermatol 2000;39:196-200.  [ PUBMED] |
| 2. | Romano G, Moretti G, Di Benedetto A, Giofrè C, Di Cesare E, Russo G, et al. Skin lesions in diabetes mellitus: Prevalence and clinical correlations. Diabetes Res Clin Pract 1998;39:101-6. |
| 3. | Mahajan S, Koranne RV, Sharma SK. Cutaneous manifestation of diabetes mellitus. Indian J Dermatol Venereol Leprol 2003;69:105-8. [ PUBMED] [Full text] |
| 4. | Oursler JR, Goldblum OM. Blistering eruption in a diabetic. Arch Dermatol 1991;127:247-50. |
| 5. | Mendes AL, Haddad V Jr. Case for diagnosis- Bullosis diabetocorum. Bras Dermatol 2007;82:94-6. |
| 6. | Cofield RH, Morrison MJ, Beabout JW. Diabetic neuroarthropathy in the foot: Patient characteristics and patterns of radiographic change. Foot Ankle 1983;4:15-22. |
[Figure 1]
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