Case presentation A 48-year-old man with total permanent incapacity presented with a neuroischemic ulcer that first appeared three months ago with a blister-like lesion in the dorsal area of the fifth toe of the right foot. Medical history The patient’s father suffered from type 2 diabetes mellitus. Both his parents had Alzheimer’s disease. The patient had a 20-year-long history of poorly controlled type 1 diabetes mellitus. His total daily insulin dose was 24 UI (breakfast 8 UI; lunch 6 UI; dinner 8 UI); pre-prandial glucose was 180 mg/dL, and HbA1c was 9%. He also suffered from hypertension, well-controlled with losartan.
He had high cholesterol levels controlled with simvastatin. He smoked 15 cigarettes a day. He also underwent trans-metatarsal amputation of his left foot eight years ago. Investigations Physical and neurological examinations were unremarkable. His ankle-brachial…
