Bullosis diabeticorum como diagnóstico diferencial de úlcera de membros: relato de caso
Bullosis diabeticorum as a differential diagnosis for limb ulcers: case report
Vinicius Tadeu Ramos da Silva Grillo; Mayra Souza Botelho; Eloana Pasqualin Lange; Murilo Sgarbi Secanho; Paula Angeleli Bueno de Camargo; Hélio Amante Miot
Resumo
Palavras-chave
Abstract
Bullosis diabeticorum (BD) is an uncommon cutaneous manifestation of diabetes that can affect the upper limbs. It is characterized by spontaneous and painless non-inflammatory bloody blisters, which can progress to necrosis, requiring differential diagnosis to rule out other dermatological diseases, such as porphyria cutanea tarda, pseudoporphyria, epidermolysis bullosa acquisita, and pemphigoid, and vascular diseases, such as vasculitis, peripheral arterial disease, and Buerger’s disease, among others. In this report, we describe a 77-year-old male patient with poorly controlled diabetes and hypertension who presented with spontaneous onset of lesions on the upper limbs, initially with bullous characteristics, progressing to necrotic ulcers after spontaneous rupture. A biopsy revealed hyaline thickening of the dermal vessels and subcorneal bullae, consistent with a diagnosis of BD. After smoking cessation and optimization of glycemia control combined with topical corticosteroid therapy, the condition improved and lesions began to heal. This presentation of BD involving the upper limbs is rare, requiring differential diagnosis to rule out other cutaneous and vascular lesions.
Keywords
References
1 Gisondi P, Fostini AC, Girolomoni G. Diabetes and the Skin. In: Bonora E, DeFronzo R, editors. Diabetes complications, comorbidities and related disorders. Cham: Springer; 2018. p. 1-15.
2 Lima AL, Illing T, Schliemann S, Elsner P. Cutaneous manifestations of diabetes mellitus: a review. Am J Clin Dermatol. 2017;18(4):541-53.
3 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;19:52-6.
4 International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2021.
5 Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clin Diabetes. 2015;33(1):40-8.
6 Sanches MM, Roda A, Pimenta R, Filipe PL, Freitas JP. Cutaneous manifestations of diabetes mellitus and prediabetes. Acta Med Port. 2019;32(6):459-65.
7 Dean SM. Cutaneous manifestations of chronic vascular disease. Prog Cardiovasc Dis. 2018;60(6):567-79.
8 Lopez PR, Leicht S, Sigmon JR, Stigall L. Bullosis diabeticorum associated with a prediabetic state. South Med J. 2009;102(6):643-4.
9 Chouk C, Litaiem N. Bullosis Diabeticorum. Treasure Island (FL): StatPearls Publishing; 2021.
10 Bernstein JE, Levine LE, Medenica MM, Yung CW, Soltani K. Reduced threshold to suction-induced blister formation in insulin-dependent diabetics. J Am Acad Dermatol. 1983;8(6):790-1.
11 Vella J. Cutaneous markers of systemic disease in the lower extremity. Clin Podiatr Med Surg. 2016;33(3):423-40.
12 Lipsky BA, Baker PD, Ahroni JH. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder. Int J Dermatol. 2000;39(3):196-200.
13 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):326-30.
Submitted date:
12/21/2021
Accepted date:
03/14/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email