<![CDATA[Tropical Diabetic Hand Syndrome (TDHS) is a rare but severe acute complication in patients with poorly controlled diabetes mellitus. It characterized by rapidly progressive hand infections leading to cellulitis, ulceration, abscess, osteomyelitis, necrosis, and gangrene. TDHS is often underrecognized and resulting in delayed treatment and high morbidity and mortality. Early trauma, can trigger TDHS in the presence of neuropathy, vascular insufficiency, and immune dysfunction. In this case reported A 55 year old Indonesian woman with history of type 2 diabetes mellitus and chronic complications presented with progressive necrosis of the right third finger following a minor injury. Initial wound management was inadequate, and the lesion worsened progressively. Clinical evaluation revealed localized necrosis with absent digital oxygen saturation and laboratory findings of anemia, impaired renal function, and signs of infection. Radiographic imaging confirmed osteomyelitis of the affected phalanx. She underwent surgical amputation and received intravenous broad spectrum antibiotics along with strict glycemic control. Multidisciplinary management facilitated recovery and prevented systemic complications. This case underscores the diagnostic challenges of TDHS. Conventional clinical assessment may underestimate severity, and early recognition is critical to prevent irreversible damage. The pathogenesis involves a combination of hyperglycemia induced immune dysfunction, peripheral neuropathy, and vascular insufficiency, exacerbated by local environmental factors. Effective management requires timely surgical intervention, antibiotics, and rigorous metabolic control. TDHS should be suspected in diabetic patients presenting with hand infections post minor trauma. Multidisciplinary and prompt treatment including surgical management is essential to improve outcomes and reduce the risk of amputation and mortality.]]>
