Rare case of duodenal tuberculosis causing gastric outlet obstruction, a case report.

INTRODUCTION AND IMPORTANCE: Intestinal tuberculosis (TB) comprises of about 5 % of all cases of tuberculosis in susceptible communities. Intestinal tuberculosis establishes itself in the lymphoid follicles of the Peyer's patches and spreads to the submucosal and subserosal planes. A gastroduodenal location for TB is very rare even in patients with pulmonary TB and gastroduodenal TB lesions are usually secondary. CASE PRESENTATION: A 48 year old Ethiopian patient presented with non-bilious, non-projectile vomiting of ingested matter which progressively worsens over time. Associated with this he had burning type of epigastric pain for which he had been treated with antiulcer drugs on multiple occasion, but he had no improvement. The vomiting worsened over the past year and he had unquantified but significant weight loss. Subsequently the patient was diagnosed with duodenal TB and was treated with antituberculous drugs according to the national protocol for six months and the above symptoms subsided. The patient had significant weight gain after starting treatment. CLINICAL DISCUSSION: The commonest site for gastro-intestinal tuberculosis (TB) is the ileocecal region and duodenal tuberculosis constitutes around 2 % of cases of abdominal tuberculosis. A high index of suspicion for tuberculosis is required in any patient with gastrointestinal symptoms living in endemic areas. CONCLUSION: We suggest that a diagnosis of duodenal tuberculosis should always be considered in young patients presenting with gastric outlet obstruction (GOO) or unresponsive or relapsing dyspepsia, in areas where tuberculosis is endemic.

Primary necrotizing fasciitis of the breast in a young patient, a case report.

BACKGROUND: Necrotizing fasciitis is a life-threatening and potentially fatal condition which commonly affects extremities, abdominal wall and perineum. However, it can affect any body part. Breasts are very rarely affected, with most of the cases are following surgical intervention or trauma. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Here we present necrotizing fasciitis of the breast in a 28-year-old female patient with no identified risk factor. CLINICAL PRESENTATION: A 28-year-old woman on her 4th month of lactation presented to the emergency department with a 4-day history of right breast pain and swelling. Associated with this, she had darkening of the skin of the right breast, high-grade fever, and foul-smelling discharge from the wound. On examination, she was febrile, tachycardic and hypotensive. Breast examination showed signs suggestive of NF. Subsequently, the patient was managed with broad spectrum antibiotics, supportive care, surgical debridement followed by partial mastectomy and finally the patient was discharged improved. CONCLUSION: Although it is a rare phenomenon, necrotizing soft-tissue infections of the breast can progress rapidly and carry a high mortality rate. Therefore, early diagnosis and immediate surgical intervention are of paramount importance. Here, we aim to show the importance of early diagnosis and the need for appropriate therapy to avoid complications and death.