As Tsuna heads to school, his body suddenly feels weak and he sees a skull on his palm. Reborn then arrives and tells Tsuna that he has the incurable disease, the Skull Disease, and that he is dying since he had been shot by ten bullets already. Tsuna heads home to try to wash the disease but fails and sees that a speech bubble arrives next to it, saying embarrassing things about him. As the speech bubbles multiply, Reborn informs Tsuna that he only has thirty minutes left to live and that he called a doctor to help him.
The doctor arrives and is instantly attacked by Bianchi. While Bianchi beats him up, Reborn tells Tsuna who he is. The doctor declines to help Tsuna, saying that he doesn’t examine guys. Tsuna begs the doctor to save him and cries when he sees that Bianchi is happy. As Shamal tries to kiss Bianchi, Kyoko arrives to bring him some boxing books from her brother. Tsuna is touched to see Kyoko before she dies and tries to hide the marks on his body from her. When Shamal tries to kiss Kyoko too, Tsuna manages to go into Dying Will Mode without the help of the bullet and is reborn with the dying will to protect Kyoko. However, after Kyoko sees the writing on his body, Tsuna sits and cries again, thinking that he is going to die as a loser. Shamal, however, decides to cure him with his trident mosquito after seeing the writing on Tsuna’s back that says that he never spoke to a girl until two months ago. Tsuna manages to escape a life threatening situation by being a loser.
Note: Bold + Italicized = First Appearance