Tuberculous meningitis is possibly complicated with multiple cerebral infarctions and basal meningitis, and the mortality and neurological prognosis is reportedly poor. This case suggested that clinicians should consider tuberculous meningitis as a differential diagnosis of patients with disturbed consciousness in an aging country Japan.

Candidemia is possibly complicated with a biofilm formation, and the mortality rate of biofilm-associated candidemia is reported very high. Herein, we described candida biofilm-related thrombophlebitis, which was successfully treated with micafungin. This case suggested that biofilm targeted therapy may be warranted in the presence of thrombus formation.

Rhinogenic optic neuropathy with hemianopia caused by sinusitisKosuke Oka, M.D., Ph. D.1, Wataru Ando2, Hideharu Hagiya, M.D. Ph. D1., Takaya Higaki, M.D., Ph. D.3and Fumio Otsuka, M.D., Ph.D.11Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;2Okayama University Medical School, Okayama 700-8558, JapanKey words: Cat scratch disease, lymphadenopathy and subcutaneous abscess3Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKey words : Rhinogenic optic neuropathy and temporal hemianopiaCorresponding author : Kosuke Oka, M.D., Ph.D.Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.Tel: +81-86-235-7342 Fax: +81-86-235-7345E-mail: [email protected] clinical messages :A patient complained of acute right vision loss and headache. A computed tomography scan revealed sinusitis in the right ethmoid sinus that was compressing the optic nerve and emergency endoscopic sinus surgery was performed.

An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.

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A 70-year-old diabetic woman was admitted to our hospital with a complaint of high fever accompanying shaking chills for three days. The patient had no abdominal symptoms and no history of eating raw food. The patient’s body temperature was increased to 39 oC, and blood analysis showed elevations of leukocytes (17,400 /µL) and C-reactive protein (16.5 mg/dL). Computed tomography revealed air density spots in the aortic wall (Fig A ), and Salmonella enteritidis serotype O9 was detected by blood culture. Under a tentative diagnosis of Salmonella-induced infective aortic aneurysm, the patient underwent antibiotic treatment with ampicillin/sulbactam. On day 11, the air had disappeared and the aortic wall showed a varicose deformity, leading to a differential diagnosis of infective aortic aneurysm (Fig B ). The patient recovered completely with 8-week antibiotic therapy without any operation.Cases of infective aortic aneurysms account for only about 1% to 3% of total cases of aortic aneurysm. However, the case fatality has been reported to be as high as 18 percent in two years1, and an early diagnosis is essential. Salmonella species are known as a common pathogen of the crucial infection2, and so clinicians should pay attention to the development of the disease.