Case presentation A 36-year-old man presented to the diabetology department with young-onset diabetes and advanced peripheral vascular disease. He had a non-healing ulcer on the greater toe and gangrene on the second toe of the left foot. Medical history The patient’s diabetes treatment started with insulin at the age of 26 and was later replaced with hypoglycemic agents. At the time of presentation, he had good glycemic control with metformin and sitagliptin. He was diagnosed with primary hypothyroidism six months ago, which was managed with levothyroxine. He had also undergone surgery for bilateral juvenile cataracts and had progressive graying and thinning of hair, atrophic changes on the skin, and progressive weight loss (Figure 1).
His elder sister and maternal uncle showed similar symptoms. Figure 1. a. The patient’s appearance at the age of 30 years. b. The patient’s appearance…
