Introduction. Granulomatosis with polyangiitis (GPA), formerly known as Wegener?s granulomatosis, is characterized by necrotizing granulomatous inflammation in various tissues, including blood vessels, but primarily in the respiratory tract and kidneys. Clinical manifestations can be diverse, including inflammation of the eye and adnexa. Optic neuritis is a very rare ophthalmological manifestation of GPA, not previously described in a teenager. Case report. We presented a case of a 16-year-old girl with a rare extrapulmonary manifestation of GPA. The girl had a previous history of GPA and complained of a sudden blurred vision in the left eye. She was promptly referred to an ophthalmologist who noted a decreased visual acuity of 20/400 in the left eye. Colour vision was impaired in the spectrum of red colour. Clinical examination revealed normal anterior segment findings. On ophthalmoscopy, the left optic nerve oedema was noted. Urgent computed tomography of the left orbit showed a soft tissue mass around the optic nerve in the apex of the orbit. Magnetic resonance imaging confirmed the diagnosis of optic perineuritis. After pulse doses of methylprednisolone, the girl achieved complete resolution of vision in the left eye. Conclusion. If untreated, inflammation of the optic nerve can lead to a permanent loss of vision. Prompt diagnostic and adequate treatment of patients with GPA is needed in order to prevent vision-threatening complications and control the systemic disease.

Myocarditis is a limited or diffuse inflammation of the heart muscle, the cause of which might be infectious (viruses, bacteria, fungi, rickettsiae, parasites, protozoas) or non-infectious (systemic diseases, metabolic diseases, toxins). There are types of myocarditis the etiological factor of which cannot be determined and therefore are classified into the group of idiopathic myocarditis. The clinical picture depends on the intensity of the inflammatory process and the lesion topography, varying from a mild form of the disease to severe malignant myocarditis followed by the development of cardiac insufficiency as well as by fatal outcome within a few days. Resting is recommended as the basic method of therapy in all of the patients with suspected myocarditis. If there are signs and symptoms of cardiac insufficiency, an anticongestive therapy must be introduced (diuretics, vasodilators, digitalis). If the conventional therapy does not produce the desired results, it is necessary to introduce continuous intravenous inotropes (dobutamine or phosphodiesterase inhibitors). Rhythm disorders in patients with myocarditis require an appropriate antiarrhythmic drug therapy that should be given as soon as possible. Acute pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub, and serial electrocardiogram (ECG) changes. Awareness of the disease has increased due to the introduction of noninvasive diagnostic techniques such as echocardiography, CT scanning, and cardiac magnetic resonance imaging (CMRI) . The disease can be severe and even lethal, especially in immunosuppressed children. The disease causative agent can usually be identified from the pericardial fluid by culture or more sensitive tests (e.g. polymerase chain reaction - PCR or from pericardial biopsy samples).

Background/Aim. Inappropriate prescribing of antibiotics to the patients with acute bronchitis is frequent event in clinical practice with potentially serious consequences, although majority of treatment guidelines do not recommend it. The aim of this study was to reveal risk factors associated with inappropriate prescribing of antibiotics to the patients with acute bronchitis in primary healthcare. Methods. This case/control study included the adult patients with acute bronchitis during the initial encounter with a general practitioner. Prescription of an antibiotic was an event that defined the case, and patients without prescribed antibiotic served as controls. Results. Antibiotics (mostly macrolides and beta-lactams) were prescribed to the majority of patients with diagnosis of acute bronchitis (78.5%). A significant association was found between antibiotic prescription rates and patient age, whether an attending physician is a specialist or not and the average number of patients a physician sees per day [ORadjustedwas 1.029 (1.007?1.052), 0.347 (0.147?0.818) and 0.957 (0.923?0.992), respectively]. Conclusion. When there is primary care encounter with patients suffering from acute bronchitis, older patients are more likely to receive inappropriate antibiotic prescription, especially if their physician is without specialist training and has less patient encounters in his/her office daily.

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