This case report describes two cases of necrotizing fasciitis due to Streptococcus pyogenes with different outcomes in a couple. Only the wife developed a fulminant course and died. The pathology of the wife’s lesion site showed weak neutrophilic infiltration. Additionally, the blood culture of the wife revealed a strain with a mutation in the virulence regulator CsrS. In contrast, pathological examination of the husband showed infiltration of numerous neutrophils and no mutation in the virulence regulator of the strain. The findings suggest that mutations in the virulence regulators of the strain might be related to fulminant course and histopathologic findings.

We hereby report the case of a 10-year-old boy with Hurler syndrome who underwent an anterior mediastinal tracheostomy due to severe limitation in performing cervical retroflexion. He was diagnosed with Hurler syndrome during his infancy period, and he had undergone a laminectomy for cervical spondylosis at the age of 4 years. Before his admission to our hospital, the patient was intubated at another hospital due to ARDS. Thence, he was referred to our hospital for further intensive care. The pneumonia improved after intensive care; however, he persistently had difficulties weaning from the ventilator and thus, needed a tracheostomy. However, the tracheostomy was considered impossible due to the fact that he suffered from severe cervical retroflexion restriction. Consequently, an anterior mediastinal tracheostomy was planned. Since this procedure is rarely performed in children, and because he had serious comorbidities, a meeting was organized with specialists from different disciplines to closely discuss the perioperative management. We particularly discussed about the surgical positioning, the intubation method, the feasibility of extracorporeal circulation, and how to deal with the risk of brachiocephalic arteriovenous dissection. The surgery was completed uneventfully, and his postoperative course was relatively good without any severe complications. He could be safely managed through multidisciplinary treatment in collaboration with various professionals.

We designed a remote clinical clerkship program using smart glasses to impart training toward the management of severe COVID-19 patients in the ICU, where bedside teaching of such patients had to be withheld for infection control. A questionnaire-based survey was conducted to determine its usefulness and the challenges encountered. Responses were obtained from 12 students and 2 supervising physicians (100% response rate). Smart glasses enabled providing safe and satisfactory clinical learning opportunities to medical students, even in the Red Zone. The need for unique teaching techniques and IT technical support was suggested. Nevertheless, with further advancements, smart glasses may be fully utilized to complement the conventional clinical clerkship in the ICU.