A 66-year-old man underwent bioradiotherapy (BRT) with cetuximab for oropharyngeal cancer. Six days after BRT he developed a fever and elevated inflammatory markers. His chest CT showed only mild radiation pneumonitis in the apex of his lung. After the initial treatment using antibiotics he showed diffuse ground glass opacity on his chest CT. He was finally diagnosed with pneumocystis pneumonia (PCP) by bronchoalveolar lavage. After oral administration of sulfamethoxazole-trimethoprim his clinical symptoms were immediately cured.
Cetuximab is a recombinant human/mouse chimeric epidermal growth factor receptor (EGFR) monoclonal antibody, which was approved for head and neck cancer in Japan in 2012. Pneumocystis pneumonia during BRT with cetuximab for head and neck cancer is extremely rare. We investigated 7 patients, including the present patient, treated by BRT with cetuximab in our hospital and found that all of the patients' lymphocytes during BRT were under 500/μl, which could be a risk factor for PCP. It should be recognized that the depletion of lymphocytes in BRT can result in PCP.

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A 46-year-old woman was referred to our hospital seeking treatment for limited mouth opening. Restriction of mouth opening was first noticed 6 years ago, after treatment of a cervical spine bone fracture. She had a maximum mouth opening of 25mm, with slightly limited lateral and anterior mandibular movement. The patient had a square face with prominent masseter muscles and mandibular angles. A dense band of tissue, which became taut during maximal opening, was palpable along the anterior border of both masseter muscles. 3DCT images (bone window) showed bilateral hyperplasia of the coronoid process. MR imaging revealed thickened aponeurosis extending far into the anterior margin of the masseter muscles.
The clinical diagnosis was restricted mouth opening due to bilateral hyperplasia of the masseter muscle aponeuorsis and coronoid process. Masseter muscle myotomy with aponeurectomy and coronoidectomy were performed bilaterally by an intraoral approach. The mouth opening improved to 53mm immediately after the surgery. The postsurgical course was uneventful and she maintained a maximal range of mouth opening of 40mm without pain and occlusal change.

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Takayasu arteritis (TKA) is a systemic vasculitis, predominantly involving the large arteries and main branches. A 37-year-old man developed bilateral sensorineural hearing loss with tinnitus 14 months prior to admission to our hospital. He had no febrile symptoms such as fever and fatigue despite an increase in the serum level of C-reactive protein. Contrast-enhanced computed tomography imaging demonstrated diffuse wall thickening of the ascending aorta and aortic arch, leading to a diagnosis of TKA. He was treated with prednisolone, concomitantly with methotrexate, resulting in complete recovery of auditory acuity. This report suggests that sensorineural hearing loss may develop as the initial and main manifestation in TKA. Furthermore, it is necessary to initiate appropriate immunosuppressive therapy based on the definite diagnosis of TKA for restoring auditory function.

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