Yersinia enterocolitica is a non-lactose-fermenting bacterium that forms colorless transparent colonies on Salmonella–Shigella (SS) agar. In 2016, lactose-fermenting Y. enterocolitica obtained from the stools of a patient with ileocecal inflammation and isolated on SS agar was confirmed by mass spectrometry. On the basis of the findings of a previous study, the bacterial species of small colonies that ferment lactose on SS agar were identified by fecal culture tests of patients presenting with clinical symptoms; as a result, five strains of Y. enterocolitica were detected. Five strains that fermented lactose on SS agar were identified as serotype O3, biotype 3, and Voges-Proskauer (VP)-reaction-negative, including three strains that were sucrose-fermenting-positive and two strains that were sucrose-fermenting-negative. VP-reaction-negative strains are difficult to extract and they form lactose-fermenting colonies on SS agar. Yersinia-selective medium should be added in routine methods when finding VP-reaction-negative strain.

α-Amanitin (AMA) is primarily a natural toxin component of poisonous mushrooms such as Amanita virosa (AV). In this study, we examined the performance of the Meixner test to detect AMA in various solvents. Although we referred to previous publications, there was a lack of information about the method of the Meixner test, such as the amount and concentration of each reagent. Therefore, in this study, we developed our own procedure named the modified Meixner test. Samples with AMA were prepared in distilled water (DW), urine, and serum. In addition, mushroom component extraction samples were also obtained. As a result of the modified Meixner test performed according to our procedure, a positive reaction was observed in samples with 200 μg/mL AMA in DW. On the other hand, the detection sensitivity decreased when the concentration of hydrochloric acid used in this study was lowered. Positive reactions were also obtained in samples with 200 μg/mL AMA in urine and serum, whereas AMA at concentrations of less than 100 μg/mL was negative in all solvents. Boiling (100°C, 30 min) of each sample did not affect the test results. The sensitivity was decreased in samples prepared in serum and urine to which hemoglobin was added, and AMA at concentrations of less than 200 μg/mL indicated a negative reaction. Three out of five samples with AMA extracted from AV showed a positive reaction with this test. The modified Meixner test showed an AMA detection sensitivity of ≥100 μg/mL, except for hemolytic and hematuria samples.

Calreticulin (CALR) is the second most mutated gene, after Janus kinase 2 (JAK2) V617F, in essential thrombocythemia and primary myelofibrosis. The detection of CALR mutations is important for not only the diagnoses of these diseases but also the predictions of their respective prognoses. In this study, we evaluated the basic performance of fragment analysis for detecting CALR mutations and assessed the usefulness of variant allele frequency for the analysis. We found that the variant allele frequency of type2 mutations detected by fragment analysis was well correlated with the actual frequency, whereas that of type1 mutations was higher than the actual frequency. The limits of detection of type1 and type2 mutations by fragment analysis based on the variant allele frequency were 3% and 4%, respectively, which is sufficient for routine examination. Fragment analysis was used to analyze mutations in patients with essential thrombocythemia or primary myelofibrosis. Among 23 patients analyzed, 14 showed type1, four showed type2, and five showed other types of mutation. Fragment analysis can be successfully applied as a screening test because it can detect different types of CALR mutation, including minor mutations, with high sensitivity. Among the 13 patients with essential thrombocythemia showing type1 mutations, the variant allele frequency was found to be positively correlated with leucocyte and platelet counts and negatively correlated with hemoglobin concentration, thereby indicating that these data are affected by the variant allele frequency of CALR.

Malassezia is a yeast-like fungus that is endemic to human and animal skin. It can be pathogenic bacteria for various diseases such as tinea versicolor, Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis, and others. Malassezia is a lipid-requiring fungus and difficult to isolate by conventional culture methods. The morphological and biochemical findings of Malassezia spp. are similar, making it very difficult to identify the species on the basis of phenotype alone. Therefore, molecular biological methods to identify fungi at the species level are used, but few laboratories are available. Recently, selective culture media have been developed, allowing for easy cultivation. However, there are only a few studies on the analysis of the isolation of Malassezia in detail. In this study, we analyzed the frequency of isolation, identification of fungi at the species level by molecular biological methods, and detection of fungi in various types of the sample using a selective culture medium. The results showed a ninefold increase in the separation frequency when using the selective medium compared with cultivation in the olive oil-stratified medium. Malassezia spp. were detected in five types of sample: otorrhea (20/43), skin (10/43), nasal swabs (9/43), sputum (3/43), and eye discharge (1/43) using 43 clinical isolates and preserved strains. All the Malassezia spp. detected were identified at the species level using molecular biological techniques. These results indicate that the selective medium increases the frequency of fungal isolation and, when combined with molecular biological techniques, identifies the species. In the future, it will be necessary to further improve the culture method and establish a simple and rapid identification method using a mass spectrometer.

The genus Rhodotorula and its relative, Sporobolomyces, are yeasts that are ubiquitous in the environment. Most of the Rhodotorula spp. isolated from clinical specimens are Rhodotorula mucilaginosa (formerly known as Rhodotorula rubra), followed by Rhodotorula glutinis and Rhodotorula minuta. We attempted to identify the 17 strains that were clinically isolated and stored (namely, 12 strains of R. mucilaginosa, 2 strains of R. glutinis, 2 strains of R. minuta, and 1 strain of Sporobolomyces salmonicolor) using the conventional method and the BD Phoenix M50 automatic identification sensitivity system (M50) in combination with the BD phoenix yeast ID panel. The concordance rate of M50 with the conventional method was 82.3% (14/17 strains). Although three strains showed different results when using M50, they were identified on the basis of their differential characteristics of nitrate reduction reaction, carcinoid pigment, and watery slime-like colonies by the conventional method. In routine examinations, the identification should be carried out using M50 first, followed by using the conventional method, because it is easy to identify the fungal species. In addition, antifungal susceptibility tests were conducted, and all the isolates were found to be sensitive to AMPH-B and 5-FC and resistant to FLCZ, MCFG, and CPFG. ITCZ and VRCZ showed inconsistent results for sensitivity and resistance. AMPH-B and 5-FC were considered effective as antifungal therapies for Rhodotorula spp. and Sporobolomyces spp.

The gold standard to detect SARS-CoV-2 is reverse transcription-polymerase chain reaction (RT-PCR). We evaluated an automated quantitative antigen assay using the Elecsys SARS-CoV-2 antigen (Roche) to detect SARS-CoV-2. We tested 214 subjects, 130 (60.7%) of whom were positive in the molecular tests for SARS-CoV-2 infection using nasopharyngeal samples, with a SARS-CoV-2 RT-PCR kit and the quantitative antigen assay. The positive concordance rate was 85.4% and the negative concordance rate was 100%. The Ct value of quantitative RT-PCR showed an inverse correlation with the logarithmically transformed antigen quantitative value (r = 0.947). Results suggest that the quantitative antigen assay is a potentially useful surrogate test for the quantitative RT-PCR assay since it also showed an acceptable accuracy as a screening test. The automated antigen assay also allows fast turn-around times and a high throughput and might be useful in emergency care, adequate bed management, and so forth.

Urinalysis is a typical non-invasive test and is widely used as a test for preliminary disease diagnosis. Recently, an increasing number of facilities have introduced automatic analyzers to improve the efficiency and speed of urine sedimentation tests. When using it, the detection limit of automatic analyzers should be determined, and urine sediment examination by microscopy should be performed for specimens with unreliable results. The significance of the values was verified by comparing the Atyp.C (atypical cell) values in the fully automated urinary particle analyzer UF-5000 with the cells and their background in urine cytology and urine sediment examination. When the cut-off value was set at 0.5/μL, the sensitivity, specificity and coincidence rates were 64.7%, 90.5% and 88.6%, respectively, for urine cytology class IV or higher as positive. A cut-off of 0.5/μL is considered appropriate when Atyp.C values are used in actual routine examinations. Many of the samples with high Atyp.C values, which deviated from the results of urine cytology, showed cells associated with inflammation, and it was inferred that this was due to the characteristics of Atyp.C value, which reflects cells associated with inflammation, such as cytoplasmic inclusion somatic cells. Specimens with low Atyp.C and deviating from urine cytology results may be due to low numbers of cells present or strong degeneration, making them difficult for the automatic analyzer to recognize. It is possible to catch atypical cells that have been overlooked until now by using Atyp.C, values. This is of great significance because it may lead to the early detection of lesions and contribute to clinical practice.

HEMLIBRA^® (emicizumab), which is used as a novel treatment for hemophilia A, is a recombinant humanized bispecific monoclonal antibody for factor IX (FIXa) and factor X (FX). By mimicking the factor VIII (FVIIIa) cofactor activity, it significantly decreases bleeding events. Emicizumab affects the results of activated partial prothrombin time (APTT), which is commonly used in coagulation assays, and the APTT-based assays of FVIII activity. We evaluated changes in the assay results of hemophilia A patients without inhibitors who have been tested by thromboelastography (TEG^®6s). Blood samples were collected from hemophilia A patients without inhibitors who started emicizumab administration at our hospital. We compared the results of TEG^®6s and coagulation assays before and after emicizumab administration. The tracing waveform of TEG^®6s after emicizumab administration showed improvement in all patients, and the result several months after the administration also showed that the improved state was maintained. Although it is necessary to confirm these results in a larger number of cases and the results when a bleeding event occurs, it is suggested that the TEG^®6s result may be used as a tool for understanding the blood coagulation dynamics of emicizumab-treated hemophilia A patients.

We evaluated the usefulness of two rapid immunoassays, C. DIFF QUIK CHEK Complete (Abbott Diagnostics Medical, QUIK CHEK) and Quick Chaser CD GDH/TOX (Mizuho Medy, Quick Chaser), for the detection of Clostridioides difficile toxins and glutamate dehydrogenase (GDH) in stool specimens. In comparison with the toxigenic culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of toxin detection were 35.3, 100, 100, and 90.7 for QUIK CHEK and Quick Chaser, respectively. On the other hand, in comparison with the toxigenic culture, the sensitivity, specificity, PPV, and NPV of GDH detection were 79.2, 100, 100, and 95.3 for QUIK CHEK and 87.5, 100, 100, and 97.1 for Quick Chaser, respectively. The sensitivity of Quick Chaser was about 8.3% higher than that of QUIK CHEK. However, the results of the detection limit test for GDH using C. difficile clinical isolates were superior in QUIK CHEK. In QUIK CHEK, specimens are aspirated using a dropper. In contrast, Quick Chaser uses a cotton swab to wipe the specimen. Therefore, Quick Chaser is less susceptible to bias in fecal specimens, which may be the reason for the difference in GDH detection sensitivity in clinical specimens. It is important to sample and test multiple areas of feces. We conclude that QUIK CHEK and Quick Chaser are almost equivalent in performance, and Quick Chaser, for which there are few data from previous studies, is also useful as the first screening immunoassay in the diagnosis of C. difficile infection.

The pathological diagnosis of renal needle biopsy specimens requires the use of various analytical methods, including the use of various special stains, immunofluorescence, immunohistochemistry, and transmission electron microscopy (TEM). Inevitably, there are many cases wherein it is difficult to make a definitive diagnosis because of insufficient materials, especially for TEM. To compensate for this, low-vacuum scanning electron microscopy (LVSEM) imaging using formalin-fixed paraffin-embedded (FFPE) specimens is being tested as a possible diagnostic tool for kidney biopsy. Here, we report a new LVSEM imaging technique using metal-sensitized immunohistochemistry. We performed immunohistochemistry on FFPE samples of kidney tissue to detect CD31 and CD34, which are used as vascular endothelial markers. We then sensitized 3,3'-diaminobenzidine (DAB) with AuCl. We also performed platinum blue and thiosemicarbazide-periodic acid-methenamine silver (TSC-PAM) staining for the control of LVSEM imaging as previously reported. LVSEM imaging of CD31 and CD34 clearly visualized glomerular endothelial cells (GECs), the peritubular capillary network, and small arteries, which are difficult to identify in the case of platinum blue or TSC-PAM staining, suggesting that LVSEM imaging can be useful in the assessment of inflammatory disease and tumor invasion. In conclusion, we established a new LVSEM imaging technique for kidney endothelium, and the AuCl sensitization of DAB can be applied to any type of immunohistochemistry to observe microstructures as well as to confirm the deposition of immune complexes in renal biopsy specimens.

Platelet aggregation is an important laboratory finding because it affects blood counts. In this study, we evaluated two cases in which the platelet aggregation flag “PLT-clumps?”was undetectable on the device, despite the presence of markedly large platelet aggregates. In the same way as in the present case, we verified using heparin-treated blood the discrepancy between platelet aggregation images and “PLT-clumps?”. The results showed the same discrepancy of results as in the present case after 20 min of blood collection. A comparison between the results obtained 10 min after blood collection and those obtained 20 min after showed a predominant increase in the number of platelets in platelet aggregates in the latter. Therefore, we inferred that the cause of the discrepancy was the number of platelets in the platelet aggregates. It is then suggested that when the platelet aggregate diameter increased owing to an increase in the number of platelets in the platelet aggregate, the device did not recognize the platelet aggregates as platelets, and “PLT-clumps?” were undetectable. Therefore, the discrepancy between platelet aggregation images and “PLT-clumps?” may occur in the case of large platelet aggregates.

We examined the accuracy and clinical usefulness of a rapid SARS-CoV-2 test, “ID NOW COVID-19” (ID NOW), which uses the nicking enzyme amplification reaction (NEAR), an isothermal nucleic acid amplification method. A total of 673 patients who visited the emergency room at Juntendo University Hospital in Tokyo between February 1 and August 25, 2021 were enrolled. Both ID NOW and real-time reverse transcription PCR (PCR method) were performed using nasopharyngeal swab samples. The PCR method showed positive results in 36 and negative results in 637 patients, whereas ID NOW showed positive results in 35 and negative results in 638 patients. Of the 36 SARS-CoV-2-positive patients determined by the PCR method, 31 were also determined to be positive by ID NOW. Of the 637 SARS-CoV-2-negative patients determined by the PCR method, 633 were also determined to be negative by ID NOW, yielding an agreement rate of 98.7%. By using the PCR method as a reference, we found that the sensitivity of ID NOW was 86.1% and the specificity was 99.4%. The cause of the four false positives could not be identified. False positives can be minimized by repeated testing of patients with positive results, having a controlled environment, and having the test performed by authorized laboratory personnel. ID NOW provides optimal performance as a point-of-care test when the tests adhere to those measures.

The global pandemic of coronavirus disease 2019 (COVID-19) has made us recognize the importance of developing a laboratory system for emerging infectious diseases in medical institutions. In particular, next-generation sequencing (NGS) analysis of the SARS-CoV-2 genome is an indispensable tool for monitoring the global COVID-19 pandemic. In Japan, the PCR testing system for SARS-CoV-2 has enabled early diagnosis and rapid infection control owing to the spread of rapid and easy-to-operate automated PCR devices. However, the number of genome analytical tests performed in a day is relatively smaller than those in other developed countries, suggesting that active epidemiological investigation has not been sufficiently conducted. To control outbreaks of emerging infectious diseases including COVID-19, rapid identification and analysis of each virus variant through genome analysis are required to determine the occurrence and frequency of mutations as early as possible. In this study, we developed a protocol for whole-genome analysis training of medical technicians, which can be practically applied in daily clinical practice using the Oxford Nanopore MinION sequencer and is characterized by its high performance, low cost, and simplicity, to establish a whole-genome analysis approach that can be implemented in clinical laboratories. Although there are still issues to be addressed, such as the availability of experimental materials and the training of medical technicians by genome analysis experts, the incorporation of sequencing technology into the daily work in clinical laboratories is expected to contribute to not only the epidemiological analysis of emerging infectious diseases but also its further applications in clinical microbiology in the future, such as bacterial identification and genetic analysis of antimicrobial-resistant bacteria. Sequencing technology is expected to be further applied to clinical microbiology in the future.

AIM: In ordinary community hospitals, how to store and use archives of histopathological specimens is usually up to their policies, and there are no general rules for the disposal, storage, and usage of such specimens. In this study, we evaluated the feasibility of DNA and RNA analyses of 50-year-old formalin-fixed, paraffin-embedded (FFPE) tissue blocks. METHODS: DNA and RNA were extracted from 50-year-old FFPE tissue blocks immunohistologically positive for TP53, and the concentrations and degradation of DNA and RNA were analyzed. Polymerase chain reaction (PCR) analysis of p53 exons 4 to 7 was conducted, and in the samples that yielded PCR products, DNA sequencing (Sanger sequencing) was conducted. RESULTS: The concentrations of DNA and RNA were 60–330 ng/μL and 450–1,145 ng/μL, and the OD ratios of DNA and RNA at 260 nm/280 nm were 1.4–1.8 and 1.8–1.9, respectively. The DNA and RNA integration numbers were 1.1–1.7 and 1.4–2.4, respectively. PCR products were successfully obtained when using primers covering 170 base pairs (bps) and less, such as the first half of exon 5 (successful in 6 out of 6 cases), the last half of exon 5 (successful in 6 out of 6 cases), and the first half of exon 7 (successful in 6 out of 6 cases); they were not successfully obtained when using primers covering 200–300 bps. Several p53 mutations were identified. RESULTS: Although degraded, DNA and RNA could be extracted from 50-year-old FFPE tissue blocks, and archived blocks could be used for research and training in a community hospital. Determination of better storage conditions would be a challenge to be addressed in future studies.

Issuing transfusion-related information cards to patients with clinically significant antibodies, which they should carry at all times, is useful for preventing delayed hemolytic transfusion reactions. The Transfusion Therapy Committee approved a proposal to have medical technologists (MTs) explain the introduced card as part of their task shift. The background, preparation, and results of the introduction of the card will be reported. Cards were issued through the transfusion system. Explanations are given in the examination room during outpatient visits. Patient guidance is indicated on the patient information sheet. Patients who underwent irregular antibody tests after the introduction of the system were included. From July 2020 to December 2021, explanations were given to 50 patients, explanations could not be given to 13 patients, and two patients were scheduled for explanations. No patient was presented with a card from another hospital during this period. The patients belonged to 10 different departments. Although there were no patients who presented cards from other hospitals, it is possible that the information was not communicated to the transfusion department because its staff did not recognize the cards. The target patients belonged to different departments, and it is considered that the explanation provided by MTs will appropriately convey the significance of the card and lead to its effective utilization. Explanation of the card is a task that can be performed under the current system, and from the perspective of task shifting, MTs should actively participate in this task.

The patient was a man in his 70s. During his previous doctor’s visit, he presented with pneumonia and a liver mass. Four months later, a CT scan showed a rapid increase in the size of the liver mass. Thus, he was referred to our hospital for further examination. Abdominal ultrasound showed a solid tumor with a maximum diameter of 8 cm, and it had a branched lobe with clear boundaries and a notch in the margin. The interior showed uniformly low brightness and nonuniformly high brightness regions. The posterior echo was enhanced, and the existing peripheral vasculature traveled through the inside of the tumor. Contrast ultrasonography showed fine early dark staining of the entire mass in the arterial dominant phase. In the portal vein dominant phase, the contrast effect began to be attenuated from the surrounding liver parenchyma, and in the Kupffer phase, a clear defective image was obtained. On MRI, the masses exhibited low-intensity T1-weighted signals, high-intensity T2-weighted signals, high-intensity diffuse enhanced signals, and low-value ADC. In a dynamic study by GD-EOB-DTPA contrast MRI, the contrast effect on tumors was poor, and a septum-like structure that gradually increased in size was observed inside. In the hepatocellular phase, the tumor showed signals with lower intensities than the surrounding liver parenchyma． A tumor biopsy revealed diffuse large B-cell lymphoma (DLBCL). I would like to report on my experience with DLBCL cases where contrast ultrasound was useful for diagnosis.

We encountered two hematological disease patients with heart disease complication, who were urgently admitted to our hospital, when they needed to prepare for transfusion with difficult-to-judge pretransfusion test results. The first patient was a 79-year-old Caucasian male who visited a physician for severe chest pain, dyspnea, and edema while traveling. He was diagnosed as having acute congestive heart failure and transported to our hospital by ambulance. The referral letter stated that he had frequently received transfusions of red blood cells (RBCs) and platelet concentrates (PCs) for myelofibrosis. On ABO blood typing upon arrival, judgment on the type of cells to transfuse was delayed because of inconsistency between cell group typing and reversed typing. AB-type PCs and O-type RBCs were transfused, partly on the basis of the presumed use of type O blood in previous transfusions in England. The second patient was a 52-year-old male who developed tachycardiac atrial flutter during hemodialysis for Bence–Jones multiple myeloma (BJ-MM)-induced kidney failure and was transferred to our hospital for ablation treatment. Treatment for BJ-MM was not mentioned in the referral letter. All irregular antibody screening cells and panel cells except for autologous blood cells were positive, and antibody identification was impossible. Upon request, the referring hospital indicated that daratumumab had been administered for three months. All DTT-treated screening cells were negative. No blood transfusion was performed. These cases show the importance of a referral letter providing a description of treatment, which may affect pretransfusion testing for safe and prompt emergency blood transfusion.

Mesothelial cells were detected in urine sediments on the anastomose urinary tract and peritoneum. We report a case of urine leakage after robot-assisted laparoscopic radical prostatectomy (RARP) detected mesothelial cells in urine sediments. A seventy-year-old man was admitted to our hospital with a complaint of anorexia and nausea. His serum K, BUN, CRE, and CRP levels suddenly increased at the time of discharge, and ascites appeared. Oval cells were seen scattered or in small clusters, and cell-to-cell apposition was recognized at the points where cells are joined. Cells had nucleoli in mononuclei and multinuclei, but no hyperchromatin was seen in the nuclei. Therefore, we identified them as mesothelial cells on the basis of these findings. K, BUN, and CRE levels in ascites were higher than those in serum. The doctor in charge suspected an anastomotic leakage on the basis of his medical history and laboratory data. Immunocytochemically, the oval cells were positive for D2-40, so they were identified as mesothelial cells. Three days later, his laboratory data returned to normal with the use of an indwelling catheter in the urinary bladder. We were able to compare the K, BUN, and CRE levels in serum with those in ascites and identified mesothelial cells by immunostaining. In addition, the discussions with the doctor in charge went smoothly. We were able to make good use of the last case’s experience.

Although methotrexate (MTX) is a highly effective drug in rheumatoid arthritis (RA) patients, it also has various side effects. Lymphoproliferative disorders (LPDs) are one of them, and they have a unique feature of disappearing when MTX is discontinued. We encountered a case in which LPD developed in an RA patient who was using MTX, and atypical cells that were considered to be derived from hematopoietic tumors were found in the patient’s urine. There have been very few reports of MTX-LPD onset in the kidney, and it was important to confirm the patient’s medical information and background.

The patient is a 67-year-old male who had been diagnosed as having hilar bile duct cancer and had been visiting our hospital for treatment. He was found collapsed on the sidewalk and was urgently transported to our hospital. He was diagnosed as having cholangitis and septic shock, and meropenem was administered as the initial treatment. Gram staining of blood culture collected on admission showed Gram-negative small rods suspected of being Haemophilus influenzae, and a bile specimen obtained by endoscopic biliary drainage only showed the same Gram-negative small rods. Culture results showed non-β-lactamase-producing ampicillin-resistant H. influenzae in both specimens. The patient was discharged from the hospital after de-escalation of antimicrobial therapy to ceftriaxone with the improvement of the inflammatory response. Invasive H. influenzae infections in adults are mainly caused by bacteremia and associated pneumonia, and although there have been reports of cholangitis-associated infections, detection of H. influenzae in bile specimens is rare. On the basis of the present case, we believe that when Gram-negative short rods are detected in bile specimens, chocolate agar culture should be considered, taking into account the possibility of H. influenzae.

The patient was a male in his 40s. He suffered from breathing difficulty, as well as chest discomfort, chills, and fever. Advanced diffuse hypocontraction and left ventricular hypertrophy (LVH) were confirmed in the left ventricle by transthoracic echocardiography (TTE). Furthermore, hypocontraction in the right ventricle was confirmed as well. He was diagnosed as having fulminant myocarditis (FM) and referred to another hospital for treatment. Once transferred to the other hospital, his hemodynamics declined and he required percutaneous cardiopulmonary support (PCPS), and intra-aortic balloon pumping (IABP) was introduced. There was no significant coarctation in the coronary artery upon coronary angiography, so a myocardial biopsy was conducted from the right ventricle. Subendocardium and intramyocardial lymphocytes, as well as plasma-cell dominant inflammatory cell infiltrate, were histologically confirmed. Five days later, we were able to remove the PCPS and IABP. Improvements of the wall motion in both the left and right ventricles and the LVH were observed upon repeat TTE. LVH and left ventricular diffuse hypocontraction determined by ultrasound examination are said to be characteristic symptoms of FM, with only a few cases reported in which complications occurred in the right ventricle abnormal wall motion. In this case, we confirmed a decline in the right ventricle wall motion along with left ventricular hypocontraction and LVH. We encountered a rare case in which we were able to observe by ultrasound exams the course of FM in both the left and right ventricles due to an infection.