{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:00Z","timestamp":1784557020643,"version":"3.55.0"},"reference-count":9,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Diabetes foot ulcer (DFU) is a common long-term complication of diabetes. Intractable chronic wounds to standard care of diabetic foot raise the question of whether other factors intervene in disease development. We report a case of a 54-year-old male patient who came to Sardjito General Hospital with leg pain and previous history of multiple debridement and amputation for DFU referred from a remote hospital yet no improvement was evident in the surrounding lesion following treatment. Consequently, a histopathological examination was carried out proving the presence of other aetiologic factors, vasculitis and panniculitis existing in the lesion. In this case, we report a rare type of causative factor of foot ulcers among diabetic patients. Vasculitis suspected for polyarteritis nodosa accompanied by panniculitis is considered in this patient. The treatment of choice is corticosteroids or immunosuppressants based on the clinical condition, contrary to usual wound care in DFU. Based on the evidence, clinicians need to consider other causes than only macrovascular complications in a diabetic patient with DFU that is intractable to standard wound care. In this patient, vasculitis may be considered in forming diabetic foot ulcers alongside macrovascular complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>A thorough examination is essential to rule out other processes in intractable DFU patients.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Prompt management based on proper diagnosis is crucial to prevent peripheral arterial disease complications.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Vasculitis and macrovascular complication are inseparable processes forming DFU in this patient.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-22-0397","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T10:51:01Z","timestamp":1704711061000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Vasculitis\u2013panniculitis mimicking unresolved diabetic foot ulcer"],"prefix":"10.1530","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4884-2832","authenticated-orcid":true,"given":"Debby Christiana","family":"Soemitha","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-9574","authenticated-orcid":true,"given":"Deshinta Putri","family":"Mulya","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemi","family":"Sinorita","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Globalization and Health","first-page":"63","article-title":"Challenges in diabetes management in Indonesia: a literature review","volume":"9","author":"Soewondo","year":"2013","unstructured":"Soewondo PFerrario A & Tahapary DL. Challenges in diabetes management in Indonesia: a literature review. Globalization and Health2013963. (https:\/\/doi.org\/10.1186\/1744-8603-9-63)"},{"key":"bib2","series-title":"Journal of Diabetes and Metabolic Disorders","first-page":"805","article-title":"Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia","volume":"20","author":"Yunir","year":"2021","unstructured":"Yunir ETahapary DLTarigan TJEHarbuwono DSOktavianda YDKristanti MIswati ESarumpaet A & Soewondo P. Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia. Journal of Diabetes and Metabolic Disorders202120805\u2013813. (https:\/\/doi.org\/10.1007\/s40200-021-00827-x)"},{"key":"bib3","series-title":"Acta Medica Indonesiana","first-page":"41","article-title":"Prediction of wound healing in diabetic foot ulcers: an observational study in tertiary hospital in Indonesia","volume":"49","author":"Soewondo","year":"2017","unstructured":"Soewondo PSuyono SSastrosuwignyo MKHarahap ARSutrisna B & Makmun LH. Prediction of wound healing in diabetic foot ulcers: an observational study in tertiary hospital in Indonesia. Acta Medica Indonesiana20174941\u201351."},{"key":"bib4","series-title":"European Journal of Vascular and Endovascular Surgery","first-page":"S60","article-title":"Chapter V: diabetic foot","volume":"42","author":"Lep\u00e4ntalo","year":"2011","unstructured":"Lep\u00e4ntalo MApelqvist JSetacci CRicco J-BDe Donato GBecker FRobert-Ebadi HCao PEckstein HHDe Rango P, et al.Chapter V: diabetic foot. European Journal of Vascular and Endovascular Surgery201142S60\u2013S74. (https:\/\/doi.org\/10.1016\/S1078-5884(1160012-9)"},{"key":"bib5","series-title":"Journal of Vascular Surgery. Venous and Lymphatic Disorders","first-page":"280","article-title":"Vasculitic and autoimmune wounds","volume":"5","author":"Shanmugam","year":"2017","unstructured":"Shanmugam VKAngra DRahimi H & McNish S. Vasculitic and autoimmune wounds. Journal of Vascular Surgery. Venous and Lymphatic Disorders20175280\u2013292. (https:\/\/doi.org\/10.1016\/j.jvsv.2016.09.006)"},{"key":"bib6","series-title":"Current Dermatology Reports","first-page":"270","article-title":"Vasculitic diseases and prothrombotic states contributing to delayed healing in chronic wounds","volume":"5","author":"Shanmugam","year":"2016","unstructured":"Shanmugam VK. Vasculitic diseases and prothrombotic states contributing to delayed healing in chronic wounds. Current Dermatology Reports20165270\u2013277. (https:\/\/doi.org\/10.1007\/s13671-016-0157-2)"},{"key":"bib7","series-title":"Dermatologic Clinics","first-page":"421","article-title":"Panniculitis","volume":"20","author":"Ter Poorten","year":"2002","unstructured":"Ter Poorten MC & Thiers BH. Panniculitis. Dermatologic Clinics200220421\u2013433. (https:\/\/doi.org\/10.1016\/s0733-8635(0200008-6)"},{"key":"bib8","series-title":"Seminars in Diagnostic Pathology","first-page":"261","article-title":"Panniculitis: a summary","volume":"34","author":"Wick","year":"2017","unstructured":"Wick MR. Panniculitis: a summary. Seminars in Diagnostic Pathology201734261\u2013272. (https:\/\/doi.org\/10.1053\/j.semdp.2016.12.004)"},{"key":"bib9","series-title":"Arthritis and Rheumatology","first-page":"1366","article-title":"American College of Rheumatology\/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody\u2013associated vasculitis","volume":"73","author":"Chung","year":"2021","unstructured":"Chung SALangford CAMaz MAbril AGorelik MGuyatt GArcher AMConn DLFull KAGrayson PC, et al.American College of Rheumatology\/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody\u2013associated vasculitis. Arthritis and Rheumatology2021731366\u20131383. 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