A diagnostic error is a failure to establish an accurate and timely explanation of the health problem of a patient or communicate that explanation to the patient. Considering that a diagnostic error may contribute to morbidity and mortality, preventive efforts should be promoted. Therefore, it is important to elucidate the relative frequency of disease category and specific diseases among patients with diagnostic errors. Although various measurements can be used to identify disease category and specific diseases in diagnostic errors, autopsy remains one of the essentials for determining the cause of death. Numerous previous reports of diagnostic errors based on autopsy used Goldman’s criteria . These criteria defined Class I errors as major diagnostic errors that could have changed the patient outcome if known before death and Class II errors as major diagnostic errors that could not have changed the patient outcome even if known before death. An autopsy series from 1960 to 1980 in a single university hospital reported Class I and II error prevalences of 10% and 12%, respectively. Recent studies reported that diagnostic errors have decreased because of advances in clinical skills and diagnostic procedures; however, the prevalence of autopsy-detected diagnostic errors remains high. In 2003, a review in US hospitals estimated that diagnostic error rate was 8.4-24.4%, specifically a Class I error rate of 4.1-6.7%. The most frequent disease categories were cardiovascular, infectious, or neoplastic diseases among the error cases. Thus, autopsy continues to play an essential role in measuring and monitoring diagnostic errors and their disease characteristics. In Japan, several studies have determined autopsy-detected diagnostic errors in the past. In 1963, the prevalence of diagnostic error in a single university hospital was 14.3%. In 2009, the prevalence of Class I errors in the same hospital was 9%. In another single-center study that reviewed 75 autopsy cases from 1983 to 1997, there was discrepancy between clinical and pathological diagnoses in 24 (32.9%) cases. A survey of internal medicine physicians throughout Japan in 1994 reported that the discrepancy between clinical and pathological diagnoses was 11.7%. However, no studies have been conducted in Japan on autopsy-detected diagnostic errors in the 21st century. Japan has had a number of diagnostic advances in technology for laboratory and imaging testing. Results of such study in contemporary Japan could elucidate common issues of diagnostic excellence in developed countries. Therefore, the current study used a large Japanese database of case series to estimate the frequency of diagnostic errors and to describe the relative frequency of its disease categories and specific diseases. The findings of this work will help physicians in modern clinical settings of Japan improve their diagnostic excellence.

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Cryptococcus neoformans is a species of yeast that is sometimes transmitted via the inhalation of infected, dried pigeon droppings. Both immunocompromised and immunocompetent individuals can be affected; the infection is primary in the latter while in the former it is called opportunistic or secondary. However, immunocompetent individuals rarely report any symptoms, and in most cases, computed tomography (CT) demonstrates solitary or multifocal nodules of primary pulmonary cryp- tococcosis (PPC). In secondary infections, various patterns, such as a mass, consolidation or cavitation, may be observed depending on the patient’s medical background and immune reaction. Pathological findings also differ among patients for these reasons. We herein describe a case of PPC with atypical radiological and pathological findings.

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Disseminated carcinomatosis of the bone marrow was reported as diffusely infiltrative carcinoma, a phenotype of bone metastasis. In Japan, Hayashi et al. in 1979 reported disseminated carcinomatosis based on the clinical and pathological characteristics of 40 cases (Japanese article). In addition to the rarity, it is difficult to diagnose because of the poor nodularity and short survival time. Disseminated carcinomatosis of the bone marrow is a disease with poor prognosis and symptoms consisting of a triad of back pain, anemia, and bleeding tendency, along with the increase of ALP and LDH. There have been many case reports of this disease, but most of them were Japanese articles from surgical departments and few autopsy series have been reported. Here, we report a case of a patient with disseminated carcinomatosis of the bone marrow who was transferred to our hospital with fever of unknown origin (FUO) and back pain, but who died due to rapidly worsening clinical conditions. We report this case along with the result of autopsy which revealed the range and the extent of cancer invasion.

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Post-exposure prophylaxis is a prevention strategy often seen in the infectious disease field, such as prevention of human immunodeficiency virus infection after high-risk sexual intercourse. Similarly, antibiotics can be used as post-exposure prophylaxis for tick-borne infections. However, when deciding whether to implement such preventive strategies, it is necessary to weigh the advantages and disadvantages of using antibiotics. For example, the incidence of adverse effects associated with antibiotic use is estimated to be 20%. Moreover, unnecessary prophylactic antibiotics can also contribute to the emergence of drugresistant bacteria. Here, we report a case in which prophylactic antibiotics for a tick-borne infection caused harm to a patient.

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Clinically amyopathic dermatomyositis (CADM), particularly that associated with positive anti-MDA5 antibody status, is linked to rapidly progressive interstitial pneumonia and has a poor prognosis, thus prompt diagnosis and treatment are crucial. Although CADM does not typically present with myositis, skin manifestations often serve as diagnostic triggers. The diagnosis becomes straightforward when typical skin symptoms such as a heliotrope rash and Gottron's signs are recognized. However, if an atypical skin lesion manifests as an initial symptom, CADM may not be considered, leading to a delayed diagnosis. Here, we report a case of anti-MDA5 antibody-positive dermatomyositis with an erysipelas-like rash on the right side of the face as the initial symptom. Because it took 3 months to establish the diagnosis, we also explored the factors that contributed to the diagnostic delay,.

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Inflammatory bowel disease (IBD) is a disease group characterized by repeated remission and relapse periods of inflammation of the gastrointestinal tract. Crohn disease (CD) and ulcerative colitis (UC) are the two most common clinical manifestations of IBD. However, IBD remains unclassified in 15-20% of pediatric patients owing to the overlapping features of CD and UC. Westernization in newly industrialized countries has increased the incidence and prevalence of IBD globally. Autism spectrum disorder (ASD) was found to be significantly associated with the subsequent incidence of IBD. The need for IBD screening in individuals with ASD was highlighted. Therefore, early diagnosis of IBD in pediatric settings is important. Herein, we report the clinical course of a young patient with ASD complicated by IBD.

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