Background: Non-invasive positive-pressure ventilation (NIPPV) is a useful tool, especially for patients with respiratory failure. Although NIPPV is accepted now as harmless and comfortable treatment tools for patients, the associated equipment can induce a critical illness if expiratory pressure is not adjusted adequately. Case: A 23-year-old male was admitted to our hospital complaining of severe abdominal pain. He had a history of congenital hypomyelination neuropathy. Because of respiratory insufficiency due to neuropathy, his doctor had prescribed NIPPV and increased end expiratory pressure three months earlier. Because abdominal computed tomography (CT) revealed ascites and pneumoperitoneum indicating gastrointestinal perforation, emergent laparotomy was performed. Intra-operative findings showed a gastric perforation and hematoma at the gastric anterior walls. The patient recovered from post-operative bowel obstruction and was transferred to pediatrics on post-admission day 26. Conclusion: Although gastrointestinal complications associated with NIPPV are rare, clinicians should be aware of possible life-threatening adverse events of the gastrointestinal rupture due to high respiratory pressure support.

Background: Neisseria meningitidis is a rare but serious pathogen that leads to life-threatening septic shock. This infection can rapidly induce a critical condition. Case 1: A 48-year-old male was transferred to our department with septic shock resulting from an unknown cause. A few days after admission, Neisseria meningitides was detected in his blood culture. Because catecholamine or massive transfusion could not support his vital signs, plasma exchange was introduced. He recovered and was discharged on post-admission day 96 without extremity amputation. Case 2: A 42-year-old male presented with sudden-onset whole-body cyanosis and shock. Although he was treated with several medications, he died on post-admission day two. Neisseria meningitidis was detected in his blood culture. Conclusion: Prompt recognition and rapid therapy, including plasma exchange, might have the potential to treat patients with this infection.