Diabetic foot ulcer with overlap syndrome: A case report and review of literature

Abstract

BACKGROUND

Diabetic foot ulcer (DFU) is a common and serious complication among individuals with diabetes. However, the co-occurrence of DFU with overlap syndrome, particularly involving anti-synthetase syndrome (ASS) and systemic sclerosis (SSc), is exceptionally rare.

CASE SUMMARY

We report a case of overlap syndrome (ASS and SSc) with diabetes manifesting as biped gangrene. The patient, a 60-year-old female, presented with painful ulcers on both heels that had persisted for nine months. She was diagnosed with DFU, which was likely attributable to SSc, suboptimal long-term glycemic control, and glucocorticoid therapy. Following four months of treatment, the patient demonstrated significant improvement and was subsequently discharged. At the one-year follow-up, the patient developed new cyanotic ulcers on the right 4^th and 5^th toes ten months post-discharge that resolved completely within 3 months following conservative management. The four-year follow-up revealed persistent intermittent cyanosis without ulcer recurrence, although progressive interstitial lung disease necessitated prolonged bed rest.

CONCLUSION

SSc-related foot ulcers demonstrate favorable outcomes when managed with conventional wound care combined with vasoactive agents.

Keywords: Diabetic foot ulcer; Overlap syndrome; Anti-synthetase syndrome; Systemic scleroderma; Case report

Core Tip: Diabetic foot ulcers (DFUs), although common in diabetes, rarely coexist with connective tissue diseases, particularly overlap syndromes. We describe a unique case involving DFUs with overlap syndrome [systemic sclerosis (SSc) and anti-synthetase syndrome (ASS)]. Literature analysis revealed three key patterns in SSc-related foot ulcers: Low incidence, predominant toe involvement, and rare diabetes comorbidity. No ASS-related foot ulcer cases have been reported. The prognosis of SSc-related foot ulcers is generally favorable, with standard DFU therapies (notably autologous platelet-rich gel) showing efficacy. Bosentan and calcium channel blockers may have therapeutic and preventive effects on SSc-related foot ulcers.