A case of a novel hemoglobin variant, Hb A2-Karatsu, discovered following a falsely elevated HbA1c value.

The patient, a man in his thirties, presented to our hospital for a secondary examination after a 2020 medical check-up found a high hemoglobin A1c (HbA1c) level on high-performance liquid chromatography (HPLC). The HbA1c level determined by HPLC (HA-8180V, fast mode) was elevated at 6.8%, but a 75-g glucose tolerance test showed normal glucose tolerance. The glycated albumin level was within the reference range at 14.6%. The continuous glucose monitoring-derived mean blood glucose and the percentage of time in range were 99 mg/dL and 98%, respectively. The HbA1c levels determined by HPLC (G9, fast mode), enzymatic assay, and immunoassay were all 5.3%. An isoelectric focusing analysis showed an abnormal band on the anode side of HbA2, and a globin gene analysis detected a heterozygous mutation at codon 144 [AAG (Lys) → TAG (stop codon)] in the δ-chain. Since this mutation is a novel δ-chain hemoglobin variant, it was given the name 'Hb A2-Karatsu'.

Shewanella infection in decompensated liver disease: a septic case.

Shewanella species are an unusual cause of disease in humans. However, reports of Shewanella infections have been increasing, and hepatobiliary disease has been proposed as a predisposing factor following a critical course. We report the first Japanese septic case of decompensated liver disease in which this bacterium acted as a definite pathogen. A 67-year-old Japanese man with primary sclerosing cholangitis was admitted to our hospital complaining of fever, general fatigue, pain, and a rash on the lower left extremity. He was tentatively diagnosed with necrotizing fasciitis caused by Vibrio vulnificus because of his decompensated cirrhotic liver and history of consuming raw fish. Thereafter, the diagnosis was altered to cellulitis and Shewanella septicemia on the basis of the characteristics of his skin lesion and an arterial blood culture. He died of multiple organ failure on the eleventh day in the hospital. Since several reports have demonstrated that Shewanella can cause lethal sepsis in patients with hepatobiliary disease, we should be aware of the pathogenicity of this bacterium.

Two cases of malignant hypertension with reversible diffuse leukoencephalopathy exhibiting a reversible nocturnal blood pressure "riser" pattern.

We report two cases of malignant hypertension with reversible diffuse leukoencephalopathy demonstrating a nocturnal blood pressure (BP) rising pattern ("riser" pattern). Case 1 was a 54-year-old man diagnosed with malignant hypertension who presented with diffuse leukoencephalopathy and nocturnal BP rise during the acute phase. These abnormal findings diminished after treatment of hypertension. Case 2 was a 50-year-old woman diagnosed with malignant hypertension in association with leukoencephalopathy, heart failure and acute renal failure. She also presented with a "riser" pattern during the acute phase. In contrast to case 1, the leukoencephalopathy and "riser" pattern in case 2 were not improved even after 1 month of treatment. Following intensive antihypertensive treatment, renal failure was improved in case 1, but renal failure was not improved after 1 month in case 2. In conclusion, a possible explanation of this phenomenon is that a causative volume overload due to renal dysfunction produced the temporal leukoencephalopathy-like brain edema and "riser" pattern in these cases.

Recurrent gastric perforation as a late complication of radiotherapy for mucosa-associated lymphoid tissue lymphoma of the stomach.

Radiation therapy can be used to treat Helicobacter pylori-negative or eradication-refractory extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the stomach. We report a case of gastric perforation which occurred more than 1 year after the completion of radiotherapy for H. pylori eradication-refractory gastric MALT lymphoma, and then recurred shortly afterwards. This was considered to be a late complication of radiation toxicity. Although gastric perforation due to radiotherapy has been reported very rarely in the past, even in advanced disease, this case shows that perforation can develop in patients with superficial disease and can relapse.