Alert for positive results of hepatitis tests in electronic medical chart is helpful for management of hepatitis carriers at non-hepatology departments. Further attempts for sufficient hepatological consultations in this alert system, such as explaining the test results to the subjects by mailing notification forms with referral to the hepatologists were adopted. The notification forms were re-mailed to the subjects without the reply in 6 months. Aggregate analysis by reviewing the charts of the subjects confirmed that the rate of hepatological consultation was improved from 49% to 72% with further attempts (p<0.001, the chi-square test). Mailing notification forms with referral to the hepatologists can be helpful for facilitating hepatological consultation in alert system of positive test results for HBV and HCV infection in electronic medical chart.

We analyzed 616 chronic hepatitis C patients who were treated with DAAs from Sep 2014 to Aug 2016 and eight acute hepatitis C patients after May 2007 in our hospital. 372 patients (60.4%) identified their infection routes via a blood transfusion, surgery, intravenous drug use (IDU), family history, and tattooing in 189, 279, 30, 18, and 24, respectively. There were no patients who were reinfected with HCV during the observation period of 34 months. Infection via IDU and tattooing still have a possibility for reinfection after SVR. These were predominant routes in young, male, and genotype 2 patients. In addition, patients who were lost to follow-up treatment showed the same backgrounds. Our data indicated that they may be candidates in a high risk group of HCV reinfection. We should observe and educate them more intensely.

A male Japanese in his 50's was admitted to our hospital because of liver dysfunction with a hepatic tumor. Blood examination revealed an elevated serum ferritin with high transferrin saturation. Abdominal CT and MRI revealed that diffusely iron-loaded liver was complicated by a tumor 15 mm in diameter. Pathological examination showed marked iron deposition within hepatocytes and Kupffer cells, and the tumor was dysplastic nodule. Six months later, abdominal MRI suggested that the nodule had progressed to hepatocellular carcinoma (HCC). It was treated by radiofrequency ablation and diagnosed as HCC pathologically.

He had a novel heterozygous mutation in the SLC40A1 gene without mutation in the other hemochromatosis genes. He was diagnosed with ferroportin disease B, but serum hepcidin-25 was as low as hemochromatosis. Regular phlebotomy had improved liver dysfunction without reccurence of HCC for 3 years. Our case is the first Japanese patient with ferroportin disease B complicated with HCC.

A 20-year-old man with social-anxiety disorder was admitted for liver dysfunction accompanied with hyperbilirubinemia. He had used ashwagandha which he imported online in combination with multiple anti-anxiety drugs on his own judgment. He had taken more than twice the recommended dosage for one month before hospitalization. Drug-induced liver injury (DILI) classified as hepatocellular type by Ashwagandha was suspected, due to a score of 8 that is "high possibility" by the DDW-J 2004 DILI diagnostic criteria. Hyperbilirubinemia became exacerbated despite the cessation of ashwagandha and concomitant drugs. Histological findings revealed many canalicular bile plugs. His liver function was normalized after initiation of ursodeoxycholic acid and phenobarbital. Here we reported a rare case of DILI with hyperbilirubinemia caused by Ashwagandha. It is facile to obtain even designated drugs such as ashwagandha by distribution system in the present day. More widely and efficient information system for attention might be needed.

A 73-years-old woman with genotype 2a chronic hepatitis C (CHC) could achieve SVR with ombitasvir/paritaprevir/ritonavir/ribavirin (OBV/PTV/r+RBV) after virologic failure with sofosbuvir/ribavirin (SOF+RBV). Although resistance-associated substitutions (RASs) in the hepatitis C virus (HCV) NS5B regions was not detected before and after SOF+RBV, she could not achieve SVR. Therefore OBV/PTV/r+RBV was administered for the patient, because OBV/PTV/r+RBV regimen for genotype 2a CHC patients showed high SVR rate in Japanese phase 3 study. After the completion of OBV/PTV/r+RBV, the patient could achieve SVR12. SOF, OBV, and PTV have the different mechanisms for elimination of HCV and that might be the reasons for why the patient could achieve SVR with OBV/PTV/r+RBV after virologic failure with SOF+RBV.