[Shewanella algae bacteremia in patients with biliary tract malignancy: report of three cases].

We encountered three cases of Shewanella algae bacteremia in patients with biliary tract malignancy. Shewanella species are mainly found in seawater and other watery environments. Human infections caused by Shewanella species have been rare. However, reports of Shewanella infections are increasing, although only a few have been from Japan. The three patients we encountered had common features, including hepatobiliary malignancy, male sex, and age over 60 years. These features are similar to those in reports from elsewhere. Shewanella infection bears consideration in patients with those characteristics who have a history of exposure to sea or fresh water or ingestion of seafood. Prompt treatment is needed as the mortality rate of this infection is high.

[A case of adult-onset type II citrullinemia in an elderly patient].

A 72-year-old man presented with consciousness disturbance. The results of brain magnetic resonance imaging and cerebrospinal fluid examination were normal, but triphasic waves were noted on electroencephalography. His plasma ammonia level was elevated due to which encephalopathy secondary to hyperammonemia was suspected. However, his liver function was normal, and no evidence of cirrhosis or portal-systemic shunt was noted. The patient's medical history revealed that he had a tendency to excessively consume pulse products since childhood, and an amino acid analysis showed elevation of citrulline and arginine levels. Thus, we diagnosed the patient with an extremely rare case of adult-onset type II citrullinemia, which was triggered by cessation of the intake of pulse foods (soybeans and peanuts) due to dental problems.