Outcomes of Diabetic Foot Ulcers in a Tertiary Referral Interdisciplinary Clinic: A Retrospective Canadian Study.

OBJECTIVES: The objectives of this work were to evaluate demographic data, healing rate, recurrence rate, amputation rate and death rate of patients with diabetic foot ulcers (DFUs) treated in a Québec outpatient diabetic foot ulcer multidisciplinary clinic. Another objective was to determine factors associated with higher ulcer recurrence. METHODS: We conducted a retrospective cohort study of adults with diabetes with a DFU referred to a Québec City diabetic foot clinic between December 1, 2013 and May 1, 2019. The primary outcome was recurrence rate at 6 months after first ulcer healing. We also evaluated the recurrence rate at 12 months, mean and median time for ulcer healing, mean and median time before recurrence after first ulcer healing, amputation rate, mortality rate and factors associated with DFU recurrence. RESULTS: Of the 85 patients included in the study, 26 (37.1%) and 36 (54.4%) had DFU recurrence at 6 months and 12 months, respectively, after first ulcer healing. Mean healing time from first consultation in the ulcer clinic was 19.64±21.02 weeks. Of the patients, 36.9% patients underwent lower limb amputation and 30.6% died during follow up. Both previous history of a DFU before first consultation and amputation after first DFU consultation were statistically significant risk factors for DFU recurrence at 12 months. CONCLUSIONS: DFU recurrence was significantly higher in patients with a past history of DFU before the first one evaluated in the diabetic foot clinic and a previous history of amputation. Thus, systematic follow up should be done specifically with these patients.

Generalized Recalcitrant Pruritus as the Presenting Manifestation of Hypereosinophilic Syndrome.

BACKGROUND AND OBJECTIVE: Pruritus is a frequent occurrence in dermatology, and investigation is often unrevealing. The authors report the case of a 65-year-old man presenting with generalized recalcitrant pruritus as the presenting manifestation of hypereosinophilic syndrome. METHODS AND RESULTS: A 65-year-old man developed intractable pruritus. Results of polymerase chain reaction clonal rearrangement were positive and led to the diagnosis and treatment. The patient also developed massive pulmonary embolism, which can be caused by chronic eosinophilia. CONCLUSIONS: This case highlights the importance of investigating patients with pruritus and unexplained persistent eosinophilia. Hypereosinophilic syndrome must be included in the differential diagnosis, which in this case presented initially as intractable pruritus. Polymerase chain reaction clonal rearrangement was key in reinforcing the diagnosis.

POEMS Syndrome Complicated by Extensive Calciphylaxis: A Remarkable Recovery.

BACKGROUND AND OBJECTIVE: Calciphylaxis is life threatening. It has traditionally been associated with end-stage renal disease and hyperparathyroidism but is increasingly common in other clinical contexts. The association of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome and calciphylaxis has been reported only in a few cases. This case is the first of patient survival in such widespread disease. METHODS AND RESULTS: A 42-year-old man with POEMS syndrome developed extensive calciphylaxis despite normal renal and parathyroid function. Rapid diagnosis, treatment, and supportive care contributed to full clinical resolution. CONCLUSION: This is the fifth case of POEMS syndrome associated with calciphylaxis. The observations from this report suggest that POEMS syndrome might be an independent risk factor for the development of calciphylaxis. This case underlines the importance of careful follow-up in patients with POEMS syndrome and prompt diagnosis and treatment of associated calciphylaxis.