Anterior Cutaneous Nerve Entrapment Syndrome Caused by a Fixation Device: A Case Report.

Anterior cutaneous nerve entrapment syndrome (ACNES) is characterized by abdominal wall neuralgia. We report an 85-year-old woman with ACNES caused by a fixation device during the bipolar hip arthroplasty. To prevent ACNES as a perioperative peripheral nerve injury, it is important to maintain patients in the appropriate position during the operation. A positive Carnett's sign means the abdominal pain originates from the abdominal wall and is useful in diagnosing ACNES. Thus, physicians should examine Carnett's sign to differentiate ACNES in patients with abdominal pain developing after an operation.

Sphingobium yanoikuyae Bacteremia, Japan.

We report a case of Sphingobium yanoikuyae bacteremia in an 89-year-old patient in Japan. No standard antimicrobial regimen has been established for S. yanoikuyae infections. However, ceftriaxone and ceftazidime treatments were effective in this case. Increased antimicrobial susceptibility data are needed to establish appropriate treatments for S. yanoikuyae.

Nocturnal Leg Cramping Caused by Carnitine Deficiency Due to Long-Term Pivalate Antibiotics Administration in a Patient With Chronic Kidney Disease.

Carnitine deficiency is a known cause of leg cramps and is sometimes observed in patients taking certain medications such as pivalate-containing antibiotics. A 69-year-old Japanese woman presented with a progression of painful involuntary nocturnal leg cramping. She had been taking cefcapene-pivoxil for six months. Serum-free carnitine (FC) and acylcarnitine levels were decreased. Then, carnitine deficiency due to long-term pivalate-containing antibiotics administration was diagnosed. After initiating oral L-carnitine treatment, her symptoms improved. It should be aware of carnitine deficiency if a patient taking pivalate-containing antibiotics presents with leg cramping.

Zoster sine herpete following BNT162b2 mRNA COVID-19 vaccination in an immunocompetent patient.

As a result of the COVID-19 pandemic, mRNA vaccination has become widespread. Recently, it has been suggested that instances of herpes zoster increase following mRNA COVID-19 vaccination. Herein, we describe the first case of zoster sine herpete (ZSH) after mRNA vaccination for COVID-19. A 60-year-old Japanese immunocompetent man presented with fever, fatigue, headache, cervical pain, and lumbar pain, which developed after receiving a second dose of BNT162b2 mRNA COVID-19 vaccination. Whereas most symptoms improved with symptomatic treatment, headache and numbness of the right forehead persisted in areas innervated by the trigeminal and second and third cervical nerves. Based on positive results of an enzyme-linked immunosorbent assay examination for anti-VZV IgM, ZSH was diagnosed, and amitriptyline improved the patient's symptoms. Diagnosis of ZSH is challenging due to the lack of a characteristic herpes zoster rash. Physicians should be aware that ZSH can develop after mRNA vaccination.

Serotonin Syndrome Triggered by Increasing the Dose of Quetiapine.

CASE PRESENTATION: An 85-year-old woman with a history of depression treated with polypharmacy including selective serotonin reuptake inhibitor presented to the emergency department with head, and upper and lower limb tremors four hours after increasing the dose of quetiapine from 12.5 milligrams (mg) per day to 25 mg/day. She was diagnosed with serotonin syndrome (SS), and all medications except clotiazepam were discontinued. The symptoms subsided within 48 hours. DISCUSSION: The use of atypical antipsychotics alone seldom increases the risk of SS. However, combining atypical antipsychotics with serotonergic agents increases the risk of SS because the activity of serotonin receptor subtype 1A is relatively enhanced. This report suggests that physicians should be aware that even a small increase in quetiapine could pose a risk of developing SS.

Cellulitis with persistent bacteremia caused by Campylobacter lari in a patient with mantle-cell lymphoma.

Campylobacter lari is an organism occasionally isolated in humans but rarely causes bacteremia. We report the first case of cellulitis with bacteremia due to C. lari in a patient undergoing mantle-cell lymphoma. A 51-year-old man presented with a two-month history of fever and bilateral leg pain and redness. Despite oral ciprofloxacin administration, his symptoms had not improved. The blood culture sample in the anaerobic bottle yielded positive results and C. lari was identified by mass spectrometry. The bacteremia did not initially respond to oral azithromycin but responded to intravenous meropenem and amikacin for five days followed by oral minocycline. This report indicates that C. lari bacteremia may be treated with oral minocycline following short-term intravenous antimicrobial therapy even among patients undergoing hematological malignancies.