Missing the boat: fatal ending to a missed case of Charcot arthropathy

Endocrinol Diabetes Metab Case Rep. 2020 Jun 16;2020:20-0013. doi: 10.1530/EDM-20-0013. Online ahead of print.

Abstract

Summary: Acute Charcot neuropathic osteoarthropathy (CN) is a clinical entity which can easily go unrecognized in its acute early stages due to lack of awareness and unspecific presentation. However, missing early diagnosis can lead to severe complications. We present the case of a 72-year-old male patient who went through the natural course of the disease unnoticed before the very eyes of his physicians leading to a tragic end. We aim to raise awareness for this rare diabetic complication, emphasizing the necessity of early diagnosis and adequate, interdisciplinary treatment.

Learning points: Clinical signs and symptoms of acute Charcot neuropathic osteoarthropathy (CN). Red flags. Importance of early diagnosis and correct treatment. Diagnostic challenges of acute CN. Awareness of high morbidity and mortality.

Keywords: 2020; Amoxicillin; Amputation; Angiography; Angioplasty; Ankle brachial index*; Bone; Brain natriuretic peptide; C-reactive protein; Cefazolin*; Charcot neuropathic osteopathy*; Clavulanic acid*; Diabetes mellitus type 2; Diabetic foot syndrome; Diuretics; Error in diagnosis/pitfalls and caveats; Erythema; Estimated glomerular filtration rate; Feet - increased size; Feet - pain; Geriatric; Geriatrics; Haemoglobin A1c; Hyperthermia; Insulin; June; Leg pain; MRI; Male; Monofilament test*; Nephropathy; Oedema; Pallanaesthesia*; Piperacillin*; Podiatry; Radiology/Rheumatology; Skin biopsy; Switzerland; Tazobactam*; White; White blood cell count; X-ray.