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Actinomycosis is an infrequent invasive bacterial disease. Although multiple different clinical features of actinomycosis have been described, pulmonary actinomycosis (PA) is a rare but challenging diagnosis and complete cure to make. Here we report the case of a 41-year-old Asian woman who had a mass-like consolidation in the right middle lung field. The lung lesion was exacerbated after initial treatment. After diagnosis of PA, thoracoscopic resection combined with intravenous and oral penicillin made a good recovery., (© The Author(s) 2019. Published by Oxford University Press.)

Approximately 70% of sudden sensorineural hearing loss (SSNHL) cases are idiopathic, but SSNHL may occasionally be related to fatality. Here, we report the case of a 54-year-old Asian female who complained of hearing loss as a primary symptom and was diagnosed with pyogenic ventriculitis (PV) derived from Streptococcus agalactiae endocarditis. Both PV and S. agalactiae endocarditis are rare and very severe infections with a high mortality rate. Rapid intensive treatment and surgery were required for successful clinical outcomes.

Cancers of unknown primary (CUPs) are challenging for physicians to diagnose and treat. Metastases to the thyroid gland are rare, representing less than 1% of all thyroid malignancies. Here, we report a case of a 69-year-old Asian man who had both thyroid gland and lymph node enlargement in the neck and shoulders but no nodules/tumours in the lung field. The patient died 51 days after his first visit to our office, although pembrolizumab was administered on day 34 based on programmed cell death-ligand 1 (PD-L1) expression. Immunohistochemistry (IHC) with paired box 8 (PAX8) may be useful to diagnostically distinguish poorly differentiated lung adenocarcinomas from napsin A-positive thyroid carcinomas.

Altered mental status is a common, yet challenging, clinical presentation encountered by physicians. Here, we report a case of a 68-year-old Japanese female who was transferred to the emergency department due to faint. The laboratory results showed hyponatremia, ketonuria, hyperglycemia and acute kidney injury without fever or inflammatory findings. Although these abnormalities were corrected, her mental status was exacerbated, and apnea/tachypnea appeared. She was eventually diagnosed with acute apical abscess and recovered immediately after dental extractions. This case suggests that odontogenic infection should be considered in the differential diagnosis of altered mental status and that interdisciplinary dental management, including surgical treatment, should be considered for patients with predisposing factors.