Charles Bonnet Syndrome With Superimposed Delirium.

Charles Bonnet Syndrome (CBS) is diagnosed when a patient who is psychiatrically intact experiences visual hallucinations in the setting of significant visual acuity or field loss. The exact pathophysiology of the CBS hallucinations remains largely unknown. The main theories include the deafferentation theory and perceptual release theory. There are suspected neurotransmitters involved, including acetylcholine and dopamine. There is no defined treatment protocol with medication for CBS, but various psychotropic medications have been used with varying degrees of remission of symptoms. This case report describes a 64-year-old male with Charles Bonnet Syndrome in the setting of superimposed delirium. We note the different medications that were trialed to reduce his CBS symptoms and decrease episodes of behavioral disturbances. Clinical features of this rare syndrome with superimposed delirium are summarized in hopes of providing directions for management and future study.

Crusted Scabies Infection in the Setting of Chronic Steroid and Omalizumab Use.

Scabies infection is a very common skin disease that occurs due to infestation with the Sarcoptes scabei mite. Typically, it results in intensely pruritic papules and excoriations in the webs of the hand, groin, or axilla, and remains limited in its spread. In rare cases, the disease can become diffuse and progress to crusted or nodular subtypes. Here, we report the case of crusted scabies infestation in a 69-year-old male who presented with a diffuse pruritic, erythematous, and petechial rash. His medical history was significant for severe idiopathic urticaria treated with omalizumab. Before starting omalizumab, the patient was self-medicating for several months with corticosteroids obtained through his veterinary practice to alleviate symptoms. His presentation was complicated by immune thrombocytopenic purpura and muscle weakness, likely secondary to omalizumab and corticosteroid use, respectively. The patient underwent an extensive rheumatologic workup until skin biopsy confirmed the underlying etiology as crusted scabies infestation. He was treated with ivermectin and weekly 5% permethrin skin cream with great improvement of his rash; however, unfortunately, he succumbed to bacterial sepsis. Scabies infestation can masquerade as a manifestation of other systemic diseases and is often misdiagnosed. As this case illustrates, initial misdiagnosis and subsequent treatment with immunosuppressive drug regimens can cause preventable, but potentially fatal, concomitant superinfections.

The F type mitochondrial genome of the scorched mussel: Brachidontes exustus, (Mytiloida, Mytilidae).

The nominal species Brachidontes exustus (Linnaeus, 1758) is a cryptic complex. Long polymerase chain reactions and direct sequencing by primer walking was used to determine the complete F type mitochondrial genome of the Gulf of Mexico clade. The genome is 16,600 bp long and contains a single large unassigned presumptive control region, 13 protein-coding genes, 23 tRNA genes, and 2 rRNA genes, all coded for on the heavy chain. As in many other bivalves, there is the addition of tRNA-Met(AUA). The gene order is different from all other mitogenomes known for the family. The B. exustus mitogenome will contribute to a better understanding of the evolutionary history and phylogenetic relationships of the Mytilidae.