Bullosis diabeticorum in a morbidly obese woman in Haiti

Axler Jean Paul, Rebecca St Louis, Adonai Aly Isaac Julien, Frednel Florvil, Wendell Blaise

Abstract


Bullosis diabeticorum is a rare skin complication of diabetes mellitus, characterized by sudden onset bullous lesions with no history of trauma. It predominantly affects men and has an acral asymmetric presentation. Here, we report a case of bullous disease in a diabetic patient with morbid obesity, the first described in Haiti. A 40-year-old woman, with a strong history of diabetic for five years, poorly controlled and morbidly obese presented to our emergency for bullosis lesions in her limb. She had a prior presentation about two years ago and, approximately a week before this actual presentation, the same symptomatology occurred suddenly without any trauma. After evaluation and screening, the diagnosis of bullosis diabeticorum was kept. She was initially treated with antibiotics due to signs of superinfection. However, as soon as the symptoms improved, antibiotics were discontinued. An antiseptic lotion and topical antibiotic, neomycin, were used along with daily dressings. About a week after, her blood glucose came to control, signs of infection disappeared as did the bullous lesions and surgical evaluation was performed to ensure proper wound evolution. She was educated by a nutritionist, and our team emphasized the importance of regular follow-up at the hospital. Diabetic bullous disease is very rare and easy to confuse with other diabetic skin complications. A good clinical history is essential to make the diagnosis, and management requires good therapeutic education to avoid the burdensome complications of diabetes.

Keywords


bullosis diabeticorum; diabetic skin complication; diabetic foot; diabetes management

Full Text:

PDF

References


Gupta V, Gulati N, Bahl J, Bajwa J, Dhawan N. Bullosis diabeticorum: rare presentation in a common disease. Case Rep Endocrinol. 2014;2014:862912. doi: 10.1155/2014/862912. PMID: 25478251; PMCID: PMC4251093.

Kang KJ, Jung S, Seo BF. Bullosis Diabeticorum: A Diabetic Bullosis, Commonly Unknown. J Wound Manag Res. 2018;14(2):112-115. doi:10.22467/jwmr.2018.00367

Piotr B, Chiriac AE, Pinteala T, Foia L, Chiriac A. Diabetic dermopathy (“shin spots”) and diabetic bullae (“bullosis diabeticorum”) at the same patient. Pak J Med Sci. 2015;31(5):1275-1276. doi:10.12669/pjms.315.7521

Shahi N, Bradley S, Vowden K, Vowden P. Diabetic bullae: a case series and a new model of surgical management. J Wound Care. 2014;23(6):326, 328-30. doi: 10.12968/jowc.2014.23.6.326. PMID: 24920203.

Willcox MJ. Recurrent Blister Formation in Setting of Poorly Managed Diabetes Mellitus. Cureus. 2019;11(6):e5029. doi: 10.7759/cureus.5029. PMID: 31497455; PMCID: PMC6716750.

Sonani H, Abdul Salim S, Garla VV, Wile A, Palabindala V. Bullosis Diabeticorum: A Rare Presentation with Immunoglobulin G (IgG) Deposition Related Vasculopathy. Case Report and Focused Review. Am J Case Rep. 2018;19:52-56. doi: 10.12659/ajcr.905452. PMID: 29332930; PMCID: PMC5776741.

Baselga Torres E, Torres-Pradilla M. Cutaneous manifestations in children with diabetes mellitus and obesity. Actas Dermosifiliogr. 2014;105(6):546-57. English, Spanish. doi: 10.1016/j.ad.2013.11.014. PMID: 24698434.

Larsen K, Jensen T, Karlsmark T, Holstein PE. Incidence of bullosis diabeticorum--a controversial cause of chronic foot ulceration. Int Wound J. 2008;5(4):591-6. doi: 10.1111/j.1742-481X.2008.00476.x. PMID: 19006577; PMCID: PMC7951251.

Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clin Diabetes. 2015;33(1):40-8. doi: 10.2337/diaclin.33.1.40. PMID: 25653473; PMCID: PMC4299750.

Nascimento A, Macedo C De. Case for diagnosis *. An Bras Dermatol. 2013;88(4):652-654. http://dx.doi.org/10.1590/abd1806-4841.20132114

Bhutani R, Walton S. Diabetic bullae. Br J Diabetes Vasc Dis. 2015;15:8-10. doi:10.15277/bjdvd.2015.004

Kansal NK, Anuragi RP. Bullous lesions in diabetes mellitus: bullous diabeticorum (diabetic bulla). BMJ Case Rep. 2020;13(8):e238617. doi: 10.1136/bcr-2020-238617. PMID: 32859620; PMCID: PMC7454193.

Wilson TC, Snyder RJ, Southerland CC. Bullosis diabeticorum: is there a correlation between hyperglycemia and this symptomatology? Wounds. 2012;24(12):350-5. PMID: 25876219.

Chen Y, Ma Y, Li N, et al. Efficacy and long-term longitudinal follow-up of bone marrow mesenchymal cell transplantation therapy in a diabetic patient with recurrent lower limb bullosis diabeticorum. Stem Cell Res Ther. 2018;9(1):99. doi: 10.1186/s13287-018-0854-9. PMID: 29631615; PMCID: PMC5891952.

El Makrini NI, Hassam B. Bullose diabétique [Diabetic bullose]. Pan Afr Med J. 2016;23:15. French. doi: 10.11604/pamj.2016.23.15.8604. PMID: 27313818; PMCID: PMC4898287.

Taylor SP, Dunn K. Bullosis Diabeticorum. J Gen Intern Med. 2017;32(2):220. doi: 10.1007/s11606-016-3802-3. PMID: 27400924; PMCID: PMC5264667.

Grillo VTRDS, Botelho MS, Lange EP, et al. Bullosis diabeticorum as a differential diagnosis for limb ulcers: case report. J Vasc Bras. 2022;21:e20210190. doi: 10.1590/1677-5449.202101901. PMID: 36187219; PMCID: PMC9477478.

Wagner G, Meyer V, Sachse MM. Bullosis diabeticorum: Zwei Kasuistiken [Bullosis diabeticorum: Two case studies]. Hautarzt. 2018;69(9):751-755. German. doi: 10.1007/s00105-018-4132-7. PMID: 29468278.

El Fekih N, Zéglaoui F, Sioud A, et al. La bullose des diabétiques: a propos de dix cas [Bullosis diabeticorum: report of ten cases]. Tunis Med. 2009;87(11):747-9. French. PMID: 20209832.

Craike P. Bullosis diabeticorum: a treatment conundrum. J Foot Ankle Res. 2011;4(Suppl 1):P12. doi: 10.1186/1757-1146-4-S1-P12. PMCID: PMC3102986.

Hamdy O, Barakatun-Nisak MY. Nutrition in Diabetes. Endocrinol Metab Clin North Am. 2016;45(4):799-817. doi: 10.1016/j.ecl.2016.06.010. PMID: 27823606.




DOI: http://dx.doi.org/10.22551/2023.41.1004.10274

Copyright (c) 2023 Axler Jean Paul, Rebecca St Louis, Adonai Aly Isaac Julien, Frednel Florvil, Wendell Blaise

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

ISSN: 2360-6975