A Rare Case of Obsessive-Compulsive Disorder with Symptoms of Unexplained Somatic and Memory Problem / General Medicine

Obsessive-compulsive disorder (OCD) is characterized by multiple obsessions and compulsions. A 22 years old woman who had mental traumatic event started having laryngopharyngeal discomfort, short term mental disturbance, and urge of repetitive checking of home door, spelling, and calculations of simple arithmetic. There was no evidence of organic causes. The diagnosis of OCD was established by meeting DSM-V criteria, and cognitive behavioral therapy was started. We report this case since it is important to consider the possibility of OCD for patients with unexplained somatic symptoms as well as unusual behavioral symptoms.

Urinary Tract Infection as a Cause of Hyperammonemic Encephalopathy / General Medicine

We report on a case of the altered mental status from hyperammonemia due to a urinary tract infection of urease-producing (urea-splitting) bacteria. A 98-year-old Japanese woman, who had no history of liver cirrhosis or portal hypertension, presented with altered mental status. The cause of the altered mental status was attributed to an elevation of ammonia in her blood. The urine culture grew Proteus vulgaris. Complete recovery occurred with the use of an antibiotic for the urinary tract infection. Among patients with urinary tract infections, but without liver cirrhosis or portal hypertension, production by urea-splitting bacteria and the subsequent tubular reabsorption of ammonia, may result in hyperammonemic encephalopathy.