A Case of Primary Tuberculosis Mastitis Revealed By a Chronical Skin Fistula

Breast tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic countries. Its frequency is low both in tuberculosis localization (0.06 to 0.1%) as well as in breast disease (0.025 to 4.5%)

Management of Tuberculous Cutaneous Fistula

Tuberculosis is an endemic emergency that is prevalent in developing countries, particularly in sub-Saharan Black Africa, including Congo-Brazzaville. In addition to the pulmonary, ganglionic, and bone forms, there are other poorly documented locations. In the Congo, among these is cutaneous tuberculosis which is exceptional. A 9-year-old boy and two adult patients had persistent lesions of the left hip and thigh wounds, chest wall, and hypogastric wound with no healing for more than four months, respectively. Among these patients, one case of tuberculous contact was noted. Histopathological examination revealed a Koester follicle, suggesting a tuberculous skin fistula. A fistulectomy was performed, coupled with a quadruple antituberculous therapy combining rifampicin, isoniazid, ethambutol, and pyrazinamide for two months, relayed by a dual therapy consisting of isoniazid and ethambutol for 6 to 8 months. The evolution was favorable in all cases with healing of the lesions after 3 to 6 weeks. The existence of inexhaustible fistulas and the absence of scarring of a wound should make one suspect, among other things, cutaneous tuberculosis. The product of fistulectomy makes it possible to establish the histological diagnosis of cutaneous tuberculosis.

FOREIGN BODY IN MAXILLARY SINUS WITH SKIN FISTULA – CLINICAL CASE

We present the case of a 41 years old patient with poor social status and previous facial trauma with a sharp object (wood branch) 2 years ago. Although it was performed the extraction of the branch in a local ENT department, the patient developed a fistula in the left genian region with the presence of puss. Two months ago the patient undergoes another head trauma leading to neurosurgery. CT scan raises the suspicion of a foreign body in the left maxillary sinus. We performed left maxillary sinus surgery through Caldwell-Luc approach with extraction of the foreign body and closure of the fistula. Surgical healing was optimal within 10 days. We analyze the medico-legal implications of such cases.

Cervical fistula caused by submandibular sialolithiasis

In oto-rhino-laryngology, cases of submandibuillar sialolithiasis are common. Submandibular sialoadentis with sialolith may cause severe complications such as deep neck abscess and sepsis. We introduce a rare case of a cervical fistula with abscess caused by submandibular sialolith. The patient had diabetes. We performed drainage of the left submandibular gland that included a Wharton duct stone and abscess by an external skin incision approach. Submandibular sialoadentis due to sialolith would likely progress to neck abscess and the formation of a neck skin fistula; moreover, the condition can be worsen by the coexistence of diabetes. This neck abscess with skin fistula could have caused potentially fatal complications such a carotid artery rupture or sepsis. In such cases the infected source should be carefully removed as soon as possible.