Scleredema — Rare skin manifestation in diabetic

Scleredema is a connective tissue disorder of unknown etiology. A 44 years diabetic, obese female patient, admitted with edema feet, erythematous, indurated hyper pigmentation with ascending progression to trunk which rapidly transformed to painless dark pigmented blister and hard non-pitting edema of anterior abdominal wall. In a week time. She was managed with broad spectrum antibiotics, was aggressively diuresed along with albumin infusion. Her skin biopsy was done which revealed scleredema. She had poor LV function due to volume overload or cardiomyopathy. After initial improvement on 14 day, she suddenly developed fulminant septicemia. Within hours, she displayed multi organ dysfunction and the heart and kidney which were already delicately balanced, decompensated. There was intractable arrhythmias and severe LV dysfunction, renal failure and ischemic hepatitis following severe hypotension. Scleredema in diabetic subjects, can be an ominous sign for producing fulminant multiorgan dysfunction and can present as cardiomyopathy, myocarditis, liver dysfunction etc., and these patients are more prone to infections or may be vice versa. Scleredema can be considered as a marker of fulminant illness in immunocompromised individuals. There is a need for treatment protocols or research into this a rather enigmatic but rare illness.