A married mother in her 50s acutely developed vomiting, diarrhoea and severe epigastric pain 2 weeks following discharge from an acute psychiatric inpatient unit. She presented to the emergency department complaining of a 2-day history of the above symptoms. Blood tests revealed neutrophilia, grossly raised inflammatory markers and amylase levels triple the normal range. Based on radiological investigations, she was treated for necrotising pancreatitis that quickly escalated to multi-system organ failure and a lengthy intensive care unit admission. Common causes of pancreatitis, including cholelithiasis, alcohol and other drugs, were ruled out. Despite this, she suffered recurrent episodes of pancreatitis with significant morbidity. Olanzapine, started during her psychiatric admission, was determined to be the offending agent. Two years following the discontinuation of olanzapine, the patient has had no further episodes of acute pancreatitis.

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Aims: This report presents one confirmed and two suspected cases of podoconiosis in the Kabale region of southwestern Uganda. Podoconiosis has not previously been described in Uganda outside of the eastern region bordering Kenya. The aim of this case report is to increase awareness of the condition in order to enhance prevention and treatment efforts. Case StudyPresentation of Cases: Podoconiosis is associated with chronic barefoot exposure to red volcanic soil, with greater prevalence in high-altitude, impoverished areas of the tropics. This report describes one confirmed case and two suspected cases. Case 1 was confirmed by a negative filarial antigen detection test. Cases 2 and 3 had negative filarial smears, but antigen detection kits were not available onsite at the time. However, the altitude at which all three patients live (>1500 masl) makes filarial disease unlikely. Discussion: Podoconiosis has not been previously reported in the region, and thus may be underdiagnosed due to a low index of suspicion among clinicians. Using adequate footwear is an important component of prevention. However, limited financial resources present a significant barrier to the use of footwear. Understanding community attitudes towards causes and risk factors is also integral to effective prevention. Conclusion:Podoconiosis has a high potential for elimination, as it is preventable and treatable in the early stages with consistent use of footwear and regular foot-washing. In addition, increased awareness among physicians and clinicians of the presence of the disease in this area can lead to early detection and treatment.

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