Progressive Supranuclear Palsy: Improvement in Cognitive-Behavioral Disturbances and Motor-Function Disabilities Following Treatment With Antidepressants and Cholinesterase Inhibitors.

Progressive supranuclear palsy (PSP) is a neurodegenerative disease that usually develops after the sixth decade of life, and the diagnosis is purely clinical except in cases of pathologically confirmed autopsies. A multidisciplinary approach to meet the patients' complex needs is the current core treatment strategy for this devastating disorder. No medications can reverse the disease course. In this report, we present a case of PSP that developed after the sixth decade of life and where the diagnosis was supported by clinical and neuroimaging data. Despite the fact that PSP is a rapidly progressive neurodegenerative disorder and no effective treatments are currently available, our case illustrates the clinically significant improvement in cognition and function achieved in a patient with a treatment involving a combination of antidepressant medications and rivastigmine.

Citrobacter braakii Bacteremia: Case Report and Review of the Literature.

Bacteremia is frequently caused by gram-positive organisms such as Staphylococcus aureus or ß hemolytic streptococci. While there is adequate information for the diagnosis and management of these common bacteria, less information is available to address bacteremia that is caused by uncommon bacteria such as Citrobacter. Citrobacter species are gram-negative bacilli that have been noted to cause infections in immune compromised patients. The re-speciation of Citrobacter by its varied genetic composition has produced 11 distinct species. While C. braakii is part of the genome species 6 of the previous Citrobacter freundii complex, there is a lack of definitive research on the subject of Citrobacter bacteremia caused by lesser- known species. We report an unusual case of Citrobacter braakii bacteremia in a patient with multiple comorbidities that presented to the hospital with cellulitis and pleural effusion. Blood cultures grew Citrobacter braakii. Despite good response to antibiotic treatment, the patient's infection proved to be persistent and he succumbed to the cirrhosis of the liver and subsequent renal failure. Multiple and fatal underlying disease processes seem to worsen the likelihood of recovery from unusual infections. We believe our case report can add to the limited data available for C. braakii.