A 37-year-old man presented to our hospital with a history of diplopia, orbital pain, and right eyelid ptosis. Magnetic resonance imaging (MRI) revealed an enlarged right cavernous sinus and internal carotid artery stenosis. Computed tomography (CT) showed multiple pulmonary nodules, some of which had formed cavities. Routine bacterial cultures from cerebrospinal fluid, sputum, and blood were all negative. Because neurological impairment rapidly progressed, urgent diagnosis was strongly required. Hence, lung tissue samples were obtained using video- assisted thoracoscopic surgery (VATs), providing a definitive diagnosis of Fusobacterium nucleatum (F. nucleatum) infection. After treatment with antimicrobial therapy, steroids, and anticoagulant therapy, he recovered without sequelae and was discharged on day 49.

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A 27-year-old woman with cervical lymphadenopathy and general malaise visited the otolaryngology department after developing a fever of 40 °C and pharyngeal pain. Levofloxacin (LVFX) was administered;subsequently, a painful petechial rash appeared on both her lower extremities. Although LVFX therapy was discontinued under the suspicion of drug eruption, the rash gradually worsened, with persistent high fever. Detailed examination included skin biopsy revealed cutaneous arteritis (CA). Treatment with high-dose corticosteroid and azathioprine was initiated. The symptoms and data were improved. Approximately one year later, the treatments were discontinued. This case was difficult to diagnose by visual inspection, but the diagnosis was rapid by skin biopsy. There was a problem in distinguishing it from drug eruption. If a patient has unknown fever and erythema, it is important to suspect CA and to perform deeper skin biopsy.

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