Vanishing bone disease: a manifestation of diabetic Charcot's neuropathic osteoarthropathy

A 50-year-old man with type 2 diabetes mellitus for 13 years presented with painless swelling of the left foot over the previous 18 weeks. He had earlier received multiple courses of antibiotics without improvement. There was no history of trauma, foot ulceration, rheumatoid arthritis or inflammatory arthropathy. His HbA1c was 7.6%, erythrocyte sedimentation rate 19 mm/hour, white blood cell count 9600/mm3 and uric acid 4.3 mg/dL. Examination revealed a swollen, erythematous, deformed left foot with rocker bottom deformity and loss of longitudinal, transverse arch (figure 1A). He had distal symmetric sensorimotor polyneuropathy up to the knee, mild non-proliferative retinopathy, no features of autonomic neuropathy, and no history of ischaemic heart disease or cerebrovascular disease. Figure 1(A) Clinical photograph of left foot (lateral view) showing typical rocker-bottom deformity. (B) X-ray of left foot (oblique view) showing destruction of mid and hind-foot bones. (C) X-ray of left foot (lateral view)....
Source: Postgraduate Medical Journal - Category: Journals (General) Authors: Tags: Journalology, General practice / family medicine, Genetics, Immunology (including allergy), Drugs: infectious diseases, Drugs: cardiovascular system, Orthopaedics, Connective tissue disease, Rheumatoid arthritis, Dermatology, Orthopaedic and trauma surger Source Type: research