Rationale:Salmonella enterica subsp arizonae is a common gut inhabitant of reptiles (snakes are the most common reservoir, but it also occurs in turtles). Alhough human cases owing to this organism are exceedingly rare, it may occasionally infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Our case is the 20th one among the infections with S arizonae in children, but the 2nd one of otitis and the first of mastoiditis. The other cases had different anatomical locations, such as gastroenteritis, osteomyelitis, meningitis, ankle infection, wound infection, and sinusitis.Patient concerns and diagnosis:We report a rare case of otitis with Salmonella in a previously healthy adolescent, which was most likely acquired after bathing in a lake. The ear infection was complicated with mastoiditis. Audiometric testing showed a moderately conductive hearing loss (60 dB on pure-tone average).Intervention:Standard therapy for S arizonae was initiated. The surgery revealed a “hidden” cholesteatoma. Surgical management comprised of canal wall up mastoidectomy with attico-antrotomy and posterior tympanotomy followed by tympanoplasty.Outcomes:Daily postoperative dressing care of the incision, along with antibiotic lavage of the external auditory canal packing, ensured a favorable evolution. The functional gain was important; the 1-month postsurgical pure tone audiogram indicated nearly normal hearing (a mean of 25 dB for air conduction thresholds).Lesson:Salmonella enterica serotype arizonae is a rare cause of human infection, being a common organism in reptiles, like snakes and turtles. Young children are at a particular risk for acquiring such infections. Our study might encourage further epidemiologic investigations into these infections to generate a more effective strategy among public health agencies.
IntroductionBecause blind patients with schizophrenia are not so many, we don't have much information about their psychotic symptoms, neither about their treatment.ObjectivesThe hallucinations of blind schizophrenic patients could be different from unblind patients, due to impairment of their visual function.AimsAnalysis of psychotic symptoms and antipsychotic treatment of blind schizophrenic patients could provide new information about their features and treatment.MethodsWe had two case studies, both diagnosed with schizophrenia, multiple episodes, currently in acute episode according to DSM V. Both patients were treated with olanzapine 10mg/day.ResultsThe psychotic symptoms of both patients had the same particularity, the presence of tactile hallucinations (both patients describe insects moving on and in the skin, with repeated attempts to remove them, producing secondary skin lesions). Both patients had a good response and remission of this symptoms after 14 days of treatment with olanzapine 10mg/day. The PANSS score had a reduction on hallucinatory behavior item from 5 to 1 for the first patient and from 6 to 2 for the second patient, for both after 14 days of treatment.ConclusionsWe presume that tactile hallucinations could be specific for these two cases. Treatment with olanzapine (an antipsychotic with a large receptoral spectrum) was a good choice in these cases.
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