Background: Capnocytophaga canimorsus infection is rare, with a high fatality rate; however, there are few cases of death with a rapid course. This study reports a progressively fatal case of C. canimorsus.Case Presentation: A 68‐year‐old immunocompetent Japanese man was bitten and scratched on his right hand by a dog 6 days before emergency transportation to the emergency room with abdominal pain, back pain, and melena. The patient developed multiple‐organ failure. Despite antibiotic therapy, transfusion, vasopressor therapy, and continuous renal replacement therapy, the patient died from uncontrolled metabolic acidosis 4.5 h after admission. Approximately 80 h after admission, blood cultures were positive for C. canimorsus.Conclusions: Capnocytophaga canimorsus infection can lead to rapid progression even in immunocompetent patients.

Background: Acute necrotizing encephalopathy (ANE), known as influenza‐associated encephalitis, typically affects children.Case presentation: A 70‐year‐old woman was admitted to the hospital with altered consciousness, a high temperature, and severe hypotension. Computed tomography (CT) of the head showed no abnormalities; thus, a diagnosis of suspected severe heat stroke was made. On day 2, repeated head CT revealed bilateral symmetrical lesions to the thalamus, and a rapid influenza antigen test was positive. Based on the CT findings and the medical history of influenza, a differential diagnosis of ANE was made. Subsequently, brain edema spread across the whole brain, and the patient died on day 21.Conclusion: In elderly patients, differentiating ANE from severe heat stroke in a high‐temperature environment is difficult because of the similarities in clinical symptoms due to multiple organ failure.

Background: We here present the first case report of takotsubo cardiomyopathy that developed during rewarming of a patient with severe accidental hypothermia with extracorporeal membrane oxygenation.Case: A 74‐year‐old woman was found unresponsive outdoors and suffered cardiopulmonary arrest during transfer to our hospital. On arrival, she was still in cardiopulmonary arrest. Veno‐arterial extracorporeal membrane oxygenation was initiated for resuscitation and rewarming. After admission to the intensive care unit, her blood pressure suddenly dropped, and coronary angiography on day 2 indicated intact coronary arteries. Left ventriculography showed typical takotsubo‐like dysfunction in the end‐systolic phase, which led to the diagnosis of takotsubo cardiomyopathy. Left ventricular wall motion gradually improved, and echocardiography on day 6 revealed that abnormalities in the left ventricular wall motion had almost disappeared.Conclusion: Takotsubo cardiomyopathy might arise during rewarming of patients with severe accidental hypothermia.

Introduction: This study aimed to describe bronchoalveolar lavage fluid (BALF) findings in cases of refractory respiratory failure, despite standard treatment, among patients with severe coronavirus disease 2019 (COVID‐19), compare BALF findings between patients with mechanical ventilation (MV) weaning success and those with failure within 28 days, and evaluate the safety and impact on respiratory mechanics of BALF examination in patients with severe COVID‐19. Methods: This study was conducted at the Department of Emergency Medicine, Sapporo Medical University, Japan. We included 21 patients with concurrent severe COVID‐19 and refractory respiratory failure who could not be weaned from MV despite standard treatment. We compared BALF cellular composition and culture results between patients who were successfully weaned from MV within 28 days and those who were not. Respiratory mechanics before and after BALF collection were also evaluated. Results: BALF analysis revealed a mixed cellular pattern with a median total cell count of 174/μL (interquartile range [IQR], 104–400/μL). The successfully weaned group showed significantly higher macrophage percentages (24.7% vs. 3.5%, p = 0.034) and counts (56.4 vs. 10.5/μL, p = 0.024) than did the failure group. The failure group had higher neutrophil proportions (34.4% vs. 8.5%, p = 0.098). Positive cultures were found in 42.9% of patients. No deterioration in respiratory mechanics was observed after BALF. Conclusions: BALF analysis revealed a mixed cellular pattern. The successfully weaned group had significantly higher macrophage percentages and counts. BALF examination can be safely performed in patients with severe COVID‐19.

(1) Background: Injuries to the upper limbs during wood splitting can affect social and economic life. We aimed to describe the clinical information concerning these injuries in Japan. (2) Methods: We identified patients from our patient database from April 2015–November 2021 and extracted data from their medical records, which includes age, gender, occupation, month, time and location of the injury, diagnosis, duration of hospitalization, ICU admission, treatment interventions including surgery, outcome, and medical costs. (3) Result: Seventeen cases were identified. Most of the patients were male (n = 15), with median age being 68 years old. Regarding the patients’ backgrounds, six were apple farmers and three were unemployed. Injuries to the index finger was most common (n = 9), followed by injuries to the thumb in five cases (n = 5). Most of the incidents occurred at home or on the patient’s farm estate. No injuries were due to incidents at work. (4) Conclusion: The wood splitter-related injuries required long-term treatment and frequently damaged the thumb, a functionally important digit. All the injuries were sustained during non-occupational use of a wood splitter. Therefore, we suggest that safety training should be provided to prevent traumatic injuries when these products are being sold.