When Diabetes Mimics Scleroderma: Cheiroarthropathy and Neuropathic Digital Erosions in Type 2 Diabetes

Diabetic cheiroarthropathy is an underrecognized complication of diabetes characterized by limited finger joint extension and thickened, waxy skin of the hands.It can clinically mimic several rheumatologic conditions, particularly systemic sclerosis, creating a diagnostic challenge.We report the case of a 68-year-old man with long-standing type 2 diabetes mellitus who presented with hand stiffness and contractures, scleroderma-like skin thickening, and nonpainful crusted digital erosions, raising concern for systemic sclerosis-associated digital ulceration.He underwent rheumatologic evaluation and received immunosuppressive therapy without improvement in the cutaneous findings, prompting further clinical reassessment.His overall clinical phenotype, including a positive prayer sign, skin thickening confined to the digits, absence of Raynaud phenomenon, normal nailfold capillaries, and negative anti-Scl-70 and anticentromere antibodies, favored diabetic cheiroarthropathy over systemic sclerosis.The digital erosions were considered likely multifactorial, with contributions from unrecognized trauma in the setting of diabetic neuropathy and possible vascular compromise related to peripheral arterial disease and tobacco use.This case highlights the clinical overlap between diabetic cheiroarthropathy and systemic sclerosis, particularly when digital erosions accompany scleroderma-like hand changes.Recognizing this presentation may help prevent misdiagnosis and unnecessary immunosuppression while directing management toward glycemic control, prevention of repetitive trauma, local wound care, and occupational therapy.