Septicaemia in pregnancy: a case report

Necrotizing fasciitis (NF) is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. It is a severe, potentially fatal infectious disease which rapidly extends from the subcutaneous tissue along the superficial and deep fascia causing vascular occlusion, ischemia, and necrosis of tissues. A 30-year-old gravida 2 para1 living 1 woman, at 32 weeks of gestation with previous caesarean section and recently diagnosed diabetes, hypertension was admitted to our hospital with signs and symptoms of severe sepsis with pruritic black lesions over abdomen and perineum. Patient was in a morbid state in our hospital. During clinical examination, fetal heart sound was not localised suggestive of intrauterine fetal demise (IUFD), with ulcerative lesions over abdomen and vulva. Patient was immediately taken for surgical intervention and was suggestive of ruptured uterus with extrusion of fetus in abdominal cavity with cellulitis of abdominal and vulva. During initial laboratory examinations, diabetes mellitus was diagnosed. Patient was kept on ventilatory support and was vitals were stabilised. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient’s postoperative course was uncomplicated and skin defect healed by second intention of healing. The following case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections

A laparoscopic management of Swyer syndrome in a woman with pure 46XY gonads and hypoplastic dysgenesis-a rare presentation

Swyer syndrome is also known as complete/pure gonadal dysgenesis & is associated with an absence of testicular differentiation in a phenotypic female with a 46, XY karyotype. A 23-year-old married girl had come with complaints of primary infertility. She was averagely built & nourished. She had well developed secondary sexual characteristics like  breast development,  axillary hairs, and  pubic hairs (Tanners stage 4) secondary to receiving HRT for getting  menses. External genitalia was of female type. Karyotype showed genotype of 46, XY. Magnetic resonance imaging revealed hypoplastic uterus with rudimentary fallopian tubes , and fibrotic gonad like tissue. A diagnosis of Swyer syndrome was made. The patient was started on hormonal replacement therapy. Dysgenetic streak gonads were removed laparoscopically . Pathologic examination revealed seminiferous tubules ,rete testis & epididymis without evidence of malignant transformation. The patient tolerated the procedure well . Thus laparoscopic prophylactic gonadectomy revealed to be an economical ,straightforward and simple procedure in this patient & risk of neoplasia could be prevented.