Ismail Mohamoud Abdullahi

Introduction: Mycetoma is a chronic, progressively destructive neglected tropical disease that presents with localised swelling, multiple sinus tracts and a discharge containing grains, and that may extend into deep tissue and bone. Somalia lies within the recognised mycetoma belt, but the national burden is poorly documented, and few patients reach specialist care early enough for the limb to be saved. Case Presentation: A 33-year-old man from Qoryooley District, Lower Shabelle, Somalia, presented with a seven-year history of progressive swelling of the right foot. Examination showed massive tumefaction and multiple discharging sinuses containing black grains. Magnetic resonance imaging demonstrated extensive soft-tissue destruction, sinus tracts, tendon involvement and osteomyelitis of several tarsal and metatarsal bones. Histopathological examination confirmed eumycetoma. Specialised fungal culture and molecular testing were not available at the institution, so the causative species could not be identified. Because the extent of soft-tissue destruction and multi-bone involvement left no viable limb-sparing option, a right below-knee amputation was performed, followed by oral itraconazole planned for twelve months. At three months the stump had healed with no clinical evidence of recurrence, and the patient continued antifungal treatment and rehabilitation. Conclusion: Delayed diagnosis of eumycetoma can cost the patient a limb. Magnetic resonance imaging determined management here by mapping the extent of disease and showing that limb-sparing surgery was no longer feasible. Earlier referral, and better access to imaging, mycological diagnosis and antifungal treatment, would spare other patients in Somalia the same outcome.

Background: Spinal mucormycosis is a rare but potentially fatal fungal infection that is often observed in immunocompromised patients, particularly in those with poorly controlled diabetes or other systemic conditions. Early diagnosis and treatment are crucial for improving patient outcomes. Case Presentation: A 55-year-old male with poorly controlled diabetes mellitus presented with throat pain, chest tightness, and dyspnea. Over the course of one year, the patient experienced repeated hospitalizations for pneumonia and pleural effusion, and subsequently developed a spinal abscess following a traditional cupping procedure. Imaging revealed severe spinal cord compression and abscess formation, extending from the thoracic spine. Initial treatment with antibiotics did not yield a significant improvement, and further imaging suggested possible tuberculosis. However, histopathological examination after thoracic spinal laminectomy confirmed the presence of mucormycosis. Management: The patient was initially started on empiric intravenous fluconazole, which was discontinued upon confirmation of mucormycosis. Definitive therapy with intravenous liposomal amphotericin B was then initiated, along with broad-spectrum intravenous antibiotics for possible secondary bacterial infection. Thoracic spinal laminectomy was performed; however, despite treatment, no recovery from paraplegia was observed, and the patient was discharged after several months of care. Discussion: Mucormycosis can present insidiously, mimicking bacterial or tuberculous infections, making early diagnosis difficult. In this case, delayed identification and treatment of the fungal infection allowed it to spread, leading to severe complications. The importance of maintaining a high index of suspicion for fungal infections in immunocompromised individuals is emphasized, particularly when standard therapies fail. Conclusion: Spinal mucormycosis is a rare but serious condition that requires prompt diagnosis and aggressive management. This case underscores the need for early recognition and a multidisciplinary approach for managing infections involving both medical and surgical interventions. Timely initiation of antifungal therapy is critical for improving patient outcomes and reduce mortality.

Fine needle aspiration cytology (FNAC) is a widely recognized, cost-effective, and minimally invasive diagnostic technique employed for the assessment of h

Introduction: Mycetoma is a neglected tropical disease characterized by chronic granulomatous infection of the subcutaneous tissues. It is classified etiologically into actinomycetoma (bacterial) and eumycetoma (fungal). Differentiation is vital as the management protocols differ significantly. Case Presentation: We report the case of a 25-year-old male from the Hiran region of Somalia who presented with a four-year history of a recurrent, discharging lesion on the right calcaneus. Magnetic Resonance Imaging (MRI) revealed the pathognomonic “dot-in-circle” sign. Intraoperative assessment revealed necrotic tissue containing characteristic black grains. Histopathological examination confirmed the presence of compact fungal grains composed of septate branching hyphae, establishing a diagnosis of eumycetoma. Conclusion: The patient was successfully treated with wide surgical debridement combined with adjuvant Itraconazole therapy. This case emphasizes the importance of histopathology and clinical grain characteristics in diagnosing fungal mycetoma in endemic regions.

Background: Fine needle aspiration cytology (FNAC) is a widely accepted, cost-effective, and minimally invasive diagnostic procedure used for the evaluation of head and neck masses. Despite its global utilization, no previous studies from Somalia have assessed the diagnostic accuracy of FNAC in non-thyroidal head and neck lesions. Objective: To evaluate the diagnostic accuracy, sensitivity, specificity, and predictive values of FNAC by correlating cytological findings with histopathological diagnoses in non-thyroidal head and neck masses. Methods: This retrospective study included 265 patients with non-thyroidal head and neck lesions who underwent FNAC followed by histopathological examination at a tertiary hospital in Somalia over five years. FNAC results were compared with corresponding biopsy findings. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated using histopathology as the gold standard. Results: A total of 265 patients underwent both FNAC and histopathological examination for non-thyroidal head and neck lesions. Of these, 145 (54.7%) were males and 120 (45.3%) were females, yielding a male-to-female ratio of 1.2:1. Lymph node lesions comprised the majority of cases (60.8%), followed by salivary gland lesions (36.2%) and miscellaneous soft tissue/cystic masses (3.0%). FNAC showed highest sensitivity in lymph node lesions (99%) and highest specificity and accuracy in salivary gland lesions (98.8% and 98%, respectively). The overall sensitivity, specificity, and accuracy were 97.1%, 96.7%, and 98.5%, respectively. Lymphomas were the most frequent malignancy diagnosed, and most salivary gland lesions were benign, with pleomorphic adenoma being the most common. Conclusion: FNAC demonstrates high diagnostic performance in evaluating non-thyroidal head and neck lesions, supporting its role as a first-line diagnostic tool, especially in low-resource settings like Somalia.

A lactating adenoma is a rare and benign breast tumor that usually occurs during pregnancy or lactation period for women. These adenomas are typically small, <3 centimeters, well circumscribed, mobile, and lobulated masses, and are most commonly witnessed in primiparous women (those having their first child) between the ages of 20 and 40 years during the third trimester of their pregnancies due to hormonal changes. In this case report, we describe an unusual variant of lactating adenoma that is characterized by the ischemic infarction of breast tissue and its giant dimensions, surpassing 16 centimeters. The case in question had poorly defined margins in addition to chronic mastitis, which can make differentiating from standard lactating adenoma presentations quite difficult clinically. Infarction associated with chronic mastitis serves to complicate the distinction, and tends to mimic inflammatory breast carcinoma. This case report emphasizes how these rare and unusual presentations of lactating adenomas can mimic a highly aggressive malignancy, leading to diagnostic confusion and potentially unnecessary interventions. Inflammatory breast carcinoma is a rapidly progressive malignancy requiring aggressive oncological management, unlike infarcted lactating adenomas, which are benign and can be effectively treated with surgical excision alone. This case adds an important dimension to the medical literature, particularly given its context of occurrence in Somalia, where resources and access to advanced diagnostic tools are limited. By detailing this unique instance, the study not only contributes to the understanding of breast pathology but also emphasizes the necessity for keen clinical acumen in achieving appropriate therapeutic interventions in diverse health-care settings.

Kikuchi-Fujimoto disease (KFD), is rare, self-limiting disorder with necrotizing lymphadenitis as its hallmark, can be difficult to diagnose because it may have multiple nonspecific features. The study presented here describes the rare type of KFD that occurred in a young male patient suffering from quadriplegia and who was wrongly diagnosed as having tuberculous lymphadenitis, which is a common cause of lymphadenopathy in tuberculosis-endemic area. A 19-year-old man had presented with two week history of fever, quadriplegia, and cervical lymphadenopathy. On physical examination revealed cervical lymphadenopathy. A laceration procedure was performed to address the lymphadenopathy. The patient was treated with anti-tubercular medication for 11 days. Currently, his urinary and bowel functions are stable, and he is fully conscious, alert, and oriented to time, place, and person. Histopathology showed classical changes in histiocytic necrotizing lymphadenitis in the lymph nodes with no evidence of either tuberculosis or neoplasm. This KFD case is particularly glaring in terms of the obstacles it presented in making a diagnosis due to its endemicity of tuberculosis. The case actually had a complicated clinical picture with KFD’s initial presentation of quadriplegia. Hence, the list of differential diagnosis should include KFD as one of the uncommon causes. Timely recognition and appropriate management of KFD can prevent unnecessary treatments and improve patient outcomes.