Antipsychotic pitfalls: idiopathic intracranial hypertension and antipsychotic-induced weight gain.

Idiopathic intracranial hypertension (IIH) is a condition associated with poor vision and headaches that can cause disability and reduced quality of life. The onset of IIH is typically associated with sudden weight gain and obesity, which may be due to first-generation or second-generation antipsychotics. This case involved the use of quetiapine in an obese, 28-year-old woman; she gained significant weight after starting the antipsychotic and later developed headaches and blurred vision. Reducing quetiapine and administering acetazolamide significantly improved her symptoms within 4 weeks. This case reminds physicians to consider IIH as a cause of headache and vision loss in patients who have gained weight after starting or increasing quetiapine.

Pitfalls in diagnosing geriatric general pain: coexistence of polymyalgia rheumatism and fibromyalgia.

Polymyalgia rheumatism and fibromyalgia are clinically similar. As there are no specific diagnostic markers, they are difficult to distinguish. A 92-year-old woman with a 3-month history of general pain, including left hip pain, was referred to our hospital. Her medical history included polymyalgia rheumatism that had been treated with prednisolone for 18 years. We found 14 of 18 symmetrical tender points. We diagnosed fibromyalgia based on two physical examinations and her personal history of general pain. Pregabalin was prescribed, and her pain gradually disappeared. About a month later, she complained of returned buttock pain and fever. She was diagnosed with exacerbation of polymyalgia rheumatism by various examinations and was treated with prednisolone. We found 3 of 18 asymmetrical tender points. No symptoms had recurred at the 1-month follow-up visit. Her case provides an opportunity to highlight the possible pitfalls when diagnosing geriatric general pain.

Lung Ultrasound for Initial Diagnosis and Subsequent Monitoring of Aspiration Pneumonia in Elderly in Home Medical Care Setting.

The number of aspiration pneumonia cases has increased in recent times. A definitive diagnosis of aspiration pneumonia is difficult in resource-limited settings where radiological equipment is unavailable. We report the initial diagnosis and subsequent monitoring of aspiration pneumonia in a home medical care setting. An 88-year-old Japanese male presented an acute onset of dyspnea, fever, and productive cough. At home, lung ultrasound displayed pleural effusion along with B-lines and subpleural consolidations. Upon admission, tests revealed increased total leucocyte counts with left-shifted neutrophils, elevated C-reactive protein levels, and positive sputum Gram stain. Chest X-ray imaging and computed tomography (CT) showed bibasilar infiltrates and wall thickening in the left S10 bronchi. The patient was diagnosed with aspiration pneumonia and treated with an antibiotic. After a 10-day hospitalization, lung ultrasound showed some remaining B-lines and disappearance of pleural effusion and subpleural consolidation. Chest X-ray image was normal, and CT revealed pleural abnormality and disappearance of bibasilar infiltrates, consistent with the ultrasound findings. Aspiration pneumonia develops with various clinical signs. However, diagnosis using chest X-ray imaging or CT in resource-limited settings is difficult. Ultrasound might allow physicians to make more accurate judgments, particularly while monitoring aspiration pneumonia following initial diagnosis in resource-limited settings.

Pitfalls in Geriatric Prescribing: Antidepressants and Extreme Sedation.

In this study, a case is presented in which initiation of an antidepressant drug was associated with an episode of extreme sedation. This case provides an opportunity to highlight possible pitfalls in geriatric prescribing.

The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study.

Yonaguni Island is a remote and isolated westernmost island in Japan, which is the fastest aging country in the world. This study evaluated the current status of medical supply-and-demand on the island and compared these results with previous surveys carried out in rural parts of Japan. This was a retrospective cohort study conducted at the Yonaguni Municipal Clinic, the only medical facility in Yonaguni Island. The participants were patients who visited the clinic over one year, between July 2015 and June 2016. We calculated the rate per 1,000 persons per month of clinic visits, referrals to off-island medical facilities (e.g., hospitals and specialist clinics), referrals to off-island emergency departments, off-island hospitalizations after referral, home visits, and overnight observations at the clinic. In total, 6,197 patients (males, 46.3%) visited the clinic. The rate of clinic visits per 1,000 persons per month was 516.4 (Standard deviation [SD] 28.1, 95% confidence interval [CI]: 500.5-532.3). The rate per 1,000 persons per month was 14.0 (SD 3.9, 95% CI: 11.8-16.2) for off-island referrals, 3.8 (SD 2.1, 95% CI: 2.6-5.0) for referrals to emergency departments, 4.8 (SD 2.6, 95% CI: 3.3-6.2) for hospitalizations, and 3.2 (SD 1.7, 95% CI: 2.2-4.1) for home visits. The rate of clinic visits was higher in Yonaguni Island than in other rural areas, although the rate of off-island referrals was lower. There were no significant differences between the number of referrals to emergency departments, hospitalizations, and home visits in Yonaguni Island, in comparison to other studies. Our study showed that patients presenting with emergencies had similar rates of healthcare-seeking behavior to those reported in previous studies in Japan; however, the referral rate was lower. We assessed the ecology of medical care in this district by evaluating patient behavior on an isolated island where access to medical care is geographically limited.

Long-term, low-dose of clarithromycin as a cause of community-acquired Clostridium difficile infection in a 5-year-old boy.

Clostridium difficile is one of the most common causes of antibiotic-associated diarrhoea. Despite C. difficile infection (CDI) has increased in all ages worldwide, episodes of CDI are often misdiagnosed due to the lack of clinical suspicion. Macrolides are also associated with CDI. Additionally, exposure to macrolides in the 12 weeks preceding infection is reported to be a significant risk factor of CDI in a child. We report here a 5-year-old Japanese boy who presented with acute onset of watery diarrhoea. He was diagnosed with community-acquired CDI induced by long-term (20 weeks), low-dose, oral clarithromycin for otitis media with effusion, and he recovered by conservative treatment. Physicians should be more cautious of community-acquired CDI in children who take long-term, low-dose macrolides, not to misdiagnose as diarrhoea by its side effect, and avoid unnecessary use of systemic antibiotics.

Exercise-induced anaphylaxis in an elderly patient.

A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, her condition stabilised. She admitted that she had a similar experience 2 years earlier while dancing. Based on her history, her symptoms were attributed to exercise-induced anaphylaxis. None of the episodes was associated with any other suspicious cotriggers of anaphylaxis. She was successfully discharged from the clinic without any complications after receiving careful guidance on how to prevent this condition.