Neuroretinitis as a Complication of Cat Scratch Disease.

In this case report, a patient with neuroretinitis from a Bartonella henselae infection is described, and insights into methods to distinguish this type of case from more common etiologies of optic nerve edema are presented. A 21-year-old female with a history of right monocular vision loss due to amblyopia presented to the emergency department (ED) with occipital headache, fever, dizziness, nasal congestion, and painless blurry vision in the left eye for one day. A lumbar puncture found a slightly high opening pressure but no evidence of meningitis. The patient was diagnosed with a viral illness and discharged with outpatient follow-up. The patient, however, had persistent central vision loss and recurring headaches and returned to the ED. Subsequent ultrasound of the patient's optic nerve revealed significant optic nerve swelling. A new working diagnosis of idiopathic intracranial hypertension was made, and the patient was started on oral acetazolamide. On the next day, she was seen by ophthalmology, and recent scratches from her cat were noted on her arm. She tested positive for B. henselae and was started on doxycycline and rifampin. Nearly two weeks after the initial presentation, a macular star pattern, indicative of neuroretinitis, was noted on the fundoscopic exam. The patient had recovered her vision by three months later. In ED cases with unilateral vision loss, early use of point-of-care ultrasound and infection with B. henselae should always be considered. Early serology testing may be warranted to allow for earlier treatment since classic signs of neuroretinitis may not be apparent at the onset.

A Rare Case of Botulism in an Adult Patient / Un caso raro de botulismo en una paciente adulta

Presentation of botulism in adults is extremely rare and symptoms can be easily confused for symptoms of acute stroke, Guillain-Barre, or myasthenia gravis. The purpose of this clinical case report is to ensure adult botulism will be included in the differential diagnoses for a patient with this presentation so swift and accurate care can be provided to ensure optimal patient outcome. A 41-year-old-female presented with complaints of sudden onset of difficulty speaking. The patient reports a history of intravenous polysubstance abuse and symptoms progressed to bilateral facial weakness, ptosis, and external ophthalmoplegia. With no notable findings from a non-contrast computed tomography and magnetic resonance imaging and given the symptoms, a diagnosis of wound botulism from intravenous drug use was made. Botulism antitoxin was given and the patient was admitted into the intensive care unit for supportive follow-up care. A colony of Clostridium species was discovered in this patient’s arm and the patient showed significant improvement after a few days of care. (AU)

La presentación del botulismo en adultos es extremadamente rara y los síntomas pueden confundirse fácilmente con los síntomas de accidente cerebrovascular agudo, Guillain-Barré o miastenia gravis. El propósito de este informe de caso clínico es garantizar que el botulismo del adulto se incluya en los diagnósticos diferenciales de un paciente con esta presentación, de modo que se pueda brindar una atención rápida y precisa para garantizar un resultado óptimo del paciente. Una mujer de 41 años presentó quejas de aparición repentina de dificultad para hablar. El paciente refiere antecedentes de abuso de múltiples sustancias por vía intravenosa y los síntomas progresaron a debilidad facial bilateral, ptosis y oftalmoplejía externa. Sin hallazgos destacables de la tomografía computarizada sin contraste y la resonancia magnética y ante la sintomatología, se realizó el diagnóstico de botulismo de la herida por uso de drogas intravenosas. Se le administró antitoxina de botulismo y la paciente fue ingresada en la unidad de cuidados intensivos para cuidados de seguimiento de apoyo. Se descubrió una colonia de especies de Clostridium en el brazo de esta paciente, mostrando una mejoría significativa después de unos días de atención. (AU)

A Case Report of Pediatric Ovarian Torsion: The Importance of Diagnostic Laparoscopy.

INTRODUCTION: Pediatric ovarian torsion is a relatively rare occurrence with chances of significant morbidity and possible mortality if not treated emergently. CASE REPORT: In this report, we review a case of pediatric ovarian torsion in a nine-year-old that was difficult to diagnose on initial presentation to the hospital due to various factors, which inevitably led to delayed resolution. CONCLUSION: We discuss the diagnosis of pediatric ovarian torsion including risk factors, symptoms, imaging modalities, and surgical diagnostics. To improve diagnosis and shorten time to treatment, this case supports the use of laparoscopy for diagnosis of ovarian torsion if indicated by clinical suspicion and supplemental imaging studies.