Sun SY, Chen DW, Wu J, Li Y, Ran XW. Diabetic foot ulcer with overlap syndrome: A case report and review of literature. World J Diabetes 2025; 16(9): 109597 [PMID: 40980290 DOI: 10.4239/wjd.v16.i9.109597]
Corresponding Author of This Article
Xing-Wu Ran, MD, Chief Physician, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. ranxingwu@163.com
Research Domain of This Article
Dermatology
Article-Type of This Article
Case Report
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Sun SY, Chen DW, Wu J, Li Y, Ran XW. Diabetic foot ulcer with overlap syndrome: A case report and review of literature. World J Diabetes 2025; 16(9): 109597 [PMID: 40980290 DOI: 10.4239/wjd.v16.i9.109597]
World J Diabetes. Sep 15, 2025; 16(9): 109597 Published online Sep 15, 2025. doi: 10.4239/wjd.v16.i9.109597
Diabetic foot ulcer with overlap syndrome: A case report and review of literature
Shi-Yi Sun, Da-Wei Chen, Jing Wu, Yan Li, Xing-Wu Ran
Shi-Yi Sun, Da-Wei Chen, Jing Wu, Yan Li, Xing-Wu Ran, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Co-first authors: Shi-Yi Sun and Da-Wei Chen.
Author contributions: Sun SY, Chen DW, Wu J, Li Y and Ran XW contributed to manuscript writing and editing; Sun SY, Wu J and Li Y contributed to data collection; Sun SY contributed to data analysis; Sun SY, Chen DW, Wu J, Li Y and Ran XW contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Supported by the 1.3.5 Project for Excellence, West China Hospital of Sichuan University, No. ZYGD24005; 1.3.5 Project of Center for High Altitude Medicine, West China Hospital, Sichuan University, No. GYYX24002; Sichuan Science and Technology Program, No. 2024YFFK0290; Health Commission of Sichuan Province, No. 23 LCYJ042; and Science and Technology Department of Sichuan Province, No. 2025ZNSFSC1621.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Xing-Wu Ran, MD, Chief Physician, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. ranxingwu@163.com
Received: May 19, 2025 Revised: June 20, 2025 Accepted: August 13, 2025 Published online: September 15, 2025 Processing time: 118 Days and 4.9 Hours
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 4th and 5th 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.
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.
