The patient was a 57-year-old woman. Even though she had received a diagnosis of tetralogy of Fallot as an student of elementary school, she did not consent to undertake surgical repair. Consequently, she had been observed until age 56, although she suffered from atrial fibrillation during this period. She decided to undergo surgical correction as she suffered from severe heart failure. The surgical repair included Maze procedure, a patch repair of ventricular septal defect, a repair of the right ventricular outflow tract and a pulmonary valve replacement. The right ventricular pressure reduced to around two-fifths of high left ventricular pressure postoperatively, and she was discharged without any complication.

A 75-year-old male visited Fuchu general hospital on foot because of possible acute mushroom poisoning. He had no symptom on admission. He twice ate some toxic mushrooms for lunch and for dinner on the previous day with his wife, who was found dead in her bed on the morning of his admission. A legally ordered autopsy was held on his wife, and a-amanitin was detected in her liver, brain and blood samples. Detection of a-amanitin in blood samples has never been reported in the literature. His liver and kidney failure rapidly progressed. He died on the 10th hospital day despite intensive treatment including hemodialysis and plasma exchange. On histological examination, his necropsy liver specimen revealed massive liver necrosis and new growth of pseudocholangioles, which apparently bore testimony to acute toxic mushroom poisoning.