Reports of hypoalbuminemia in patients with syphilis are rare, except in cases complicated by nephrotic syndrome. We report a case of syphilis-associated hypoalbuminemia in the absence of nephrotic syndrome. In this patient, hypoalbuminemia was likely multifactorial, including albumin leakage into the extravascular space and decreased albumin production due to syphilitic inflammation, endothelial glycocalyx damage associated with long-standing diabetes mellitus, and malnutrition. These factors collectively impaired albumin synthesis. Patients with syphilis accompanied by unexplained hypoalbuminemia may experience improvement in their serum albumin levels following appropriate treatment for syphilis.

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Essential palatal tremor (EPT) is a movement disorder characterized by rhythmic contraction of the tensor veli palatini accompanied by a clicking sound, without other symptoms. The pathogenesis of EPT is reported unrelated to the central pattern generator system. Our case is that of 33-year-old man who complained of a clicking sound in his right ear. There is no established consensus for the treatment in EPT; however, anti-epileptic drugs are relatively common. To avoid the sleepiness associated with anti-epileptic drugs, we treated the patient with Shakuyaku-kanzo-to (Shao-yao-gan-cao-tang), and he showed remarkable improvement. Shakuyaku-kanzo-to is a Chinese traditional medicine known to affect muscle directly to stop muscle cramping. This case shows the effectiveness of Shakuyaku-kanzo-to for the treatment of EPT.

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A 74-year-old woman receiving long-term prednisolone for cardiac sarcoidosis presented with altered consciousness. Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) had been discontinued 10 months prior due to hyperkalemia. Blood cultures identified Listeria monocytogenes and central nervous system involvement was suspected. Treatment with intravenous ampicillin and gentamicin were completed without neurological sequelae. Invasive listeriosis should be considered in immunocompromised elderly patients presenting with altered mental status, particularly those not receiving TMP-SMX prophylaxis. This case suggests a potential protective role for TMP-SMX against listeriosis in this population.

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Bleeding from stomas is rare, and stomal varices are often overlooked in differential diagnoses. We report a case of massive bleeding from ileal conduit stomal varices in a 63-year-old man with alcoholic cirrhosis. Minimally invasive mucocutaneous dissection and vascular ligation achieved temporary hemostasis for two years. Older aged patients often struggle with treatment, partly because access to interventional radiology is difficult. This case underscores the importance of recognizing stomal varices as a potential cause of bleeding and emphasizes tailoring treatment strategies to patient prognosis and quality of life.

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A 54-year-old woman arrived at the emergency department with a two-day history of left lower abdominal pain. Prior consultations at three hospitals had resulted in a diagnosis of constipation. Upon arrival, signs of disturbed consciousness, pyrexia, and tachypnea were observed. Laboratory findings showed a significantly elevated inflammatory response and pyuria in blood and urinary tests. Computed tomography revealed dilation of the left renal pelvis, increased density of the left perirenal fat tissue, and the presence of a left ureteral stone. The patient was diagnosed with calculous pyelonephritis. This case illustrates that doctors should exercise caution in diagnosing constipation.

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In recent years, the number of cases of non-tuberculosis mycobacterial infection has increased in Japan; Mycobacterium abscessus is the third most common after M. avium and M. intracellulare. There are three subspecies of M. abscessus; their identification is important because the presence or absence of inducible macrolide resistance differs between these subspecies. Diagnostic advancements, such as mass spectrometry and genetic methods, have facilitated identification. However, subspecies identification remains challenging. We report a method for M. abscessus subspecies identification based on an isolate identified in a patient with otitis media and mastoiditis. Multiplex polymerase chain reaction (PCR) was initially used to identify the subspecies. However, the band pattern of the PCR products differed from that of any known M. abscessus subspecies. Whole-genome sequencing was performed, using 16S rRNA, hsp65, and rpoB as sequence references. Although these sequences were compared with those of the reference strain, no matches were found. The isolate was finally identified as M. abscessus subsp. massiliense by phylogenetic analysis of the core genome. M. abscessus subspecies identification remains difficult despite the availability of various testing methods. The development of new techniques and the accumulation of results from newly developed kits are needed.

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An older man who had had an episode of acute cholecystitis three years previously presented with acute onset of dyspnoea and fever. Physical examination revealed non-reproducible tenderness in the right upper quadrant, without jaundice. Laboratory testing showed leucocytosis and an elevated C-reactive protein level, with liver function test results within normal limits. Plain computed tomography revealed a common bile duct stone, raising suspicion of acute cholangitis. The patient’s symptoms improved following endoscopic biliary drainage and antibiotic therapy. Although acute cholangitis is typically diagnosed based on systematic inflammation, cholestasis, and imaging findings, it may present without jaundice or liver enzyme abnormalities. This case demonstrates the importance of considering imaging studies even when liver function tests are within normal limits, because early diagnosis and treatment of acute cholangitis are crucial for reducing morbidity and mortality.

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Eltrombopag, a thrombopoietin receptor agonist, is widely used in the treatment of immune thrombocytopenia (ITP) for its efficacy in raising platelet counts. However, its prothrombotic potential remains a significant concern. We report a case of a woman in her 70s with chronic ITP who developed multiple systemic thrombotic events―including bilateral cerebral infarctions, pulmonary embolism, deep vein thrombosis, and splenic infarction―shortly after initiating eltrombopag therapy. Notably, the patient had no prior history of thromboembolic disease or underlying hypercoagulable conditions. This case underscores the critical need for thorough screening for silent thrombi prior to eltrombopag administration, even in patients without apparent risk factors. Early identification of asymptomatic thrombi would help prevent devastating complications associated with this medication.

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In Japan, home care support clinics and hospitals (HCSCs) are expected to play an important role in healthcare. However, the role of home care support “hospitals” (HCSHs) that are independent of clinics remains a focus of attention. Here, we describe an elderly patient with multiple comorbidities who was admitted to a HCSH and spent her final days at home, supported by a team within the facility. She was admitted for obstructive pneumonia secondary to suspected lung cancer complicated by exacerbation of heart failure, acute cholecystitis, and masses in the ascending colon and bilateral adrenal glands. She was introduced to home care by our hospital team and died at home shortly after discharge. HCSHs could provide essential home care to inpatients, particularly those with rapidly progressing malignancies.

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