Necrotizing fasciitis of the breast: a case managed without mastectomy.

OBJECTIVE: To report a rare presentation of necrotizing fasciitis (NF) in the breast and its management. CLINICAL PRESENTATION AND INTERVENTION: A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. CONCLUSION: This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively.

Primary hepatic carcinoid tumor.

OBJECTIVES: To describe a rare case of primary carcinoid tumor of the liver and its management. CLINICAL PRESENTATION AND INTERVENTIONS: A 44-year-old Nigerian male presented with a big inoperable liver mass, which proved to be a carcinoid tumor by fine needle aspiration cytology. Extensive search for a primary lesion including laparotomy and peroperative ultrasound failed to find a primary lesion in the gastrointestinal tract and pancreas. Percutaneous embolization of the tumor followed by complete dearterializations of the liver seemed to have halted the growth of the tumor. The patient remained well with normal liver function tests for 56 months when he decided to go back to his country. CONCLUSION: The result showed that dearterializations of a primary inoperable carcinoid of the liver offered good palliation.

Musculoskeletal manifestations with panniculitis--a hospital based study on 62 patients in Kuwait.

The study describes 62 patients seen over a period of 4 years mainly presenting with an acute inflammatory ankle arthritis/periarthritis associated with panniculitis. Based upon the clinical characteristics of panniculitis two distinct categories could be defined. These included patients with characteristic lesions of erythema nodosum, seen in 51 (82%), the idiopathic form in 29 (57%), and secondary EN in 22 (43%). Associated conditions included Behçet's disease, oral contraceptive pills, pregnancy and penicillin treatment. Patients clinically not having typical EN was seen in 11 (18%). In this group the histopathology showed erythema induratum in 4, cutaneous-polyarteritis nodosa with minimal panniculitis in 3, Weber-Christian disease, cytophagic histiocytic panniculitis, and 'mixed' lobular and septal variety of panniculitis in 1 each. (In 1 patient the disease was not panniculitis but cutaneous variant of granuloma annulare). It is concluded that in a hospital setting EN associated with acute musculoskeletal symptoms, mainly ankle arthritis/periarthritis or an acute peripheral polyarthritis, was a common rheumatological problem in Kuwait. However, other forms of panniculitides also presented with musculoskeletal manifestations requiring accurate histopathological diagnosis for appropriate treatment.