Sodium lauryl sulfate （SLS） is a strong anionic surfactant that has been traditionally utilized as a foaming agent mixed in hair washes, face washes, toothpastes, and mouthwashes. Since Kowitz et al. first reported in 1973 that SLS in toothpaste could cause oral mucosal peeling as a side effect, there have been similar reports in Europe and the United States. However, there have been only a few reports and the side effects are not well recognized in Japan. Here, we report a case of oral mucosal peeling associated with SLS in toothpaste. The patient was a 96-year-old woman, who was referred to our hospital in June 2023 having an unusual white membrane that peeled easily on the bilateral buccal mucosa, tongue dorsum, and gingival surface. No pain, bleeding, redness, or dryness in her oral mucosa was observed. During the initial examination, we performed a biopsy of the peeling membrane which resulted in several keratinized layers of superficial epithelium. We treated her condition by advising her to switch toothpaste to a SLS-free one. Consequently, the lesion completely improved within two weeks.

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A brain abscess is an inflammatory condition characterized by the accumulation of pus in the brain parenchyma due to bacterial invasion. We report a case of a brain abscess in a young, healthy patient, suspected to have been triggered by an odontogenic infection. A 20-year-old female patient was urgently brought to our emergency department with altered consciousness, motor impairment, headache, and visual field disturbances. Imaging studies revealed a lesion in the left parietal lobe with surrounding edema, and blood tests indicated a significant inflammatory response. She was diagnosed with a brain abscess, and the neurosurgery department performed an emergency drainage procedure, followed by antimicrobial therapy. Streptococcus constellatus, Fusobacterium nucleatum, and Actinomyces sp. were identified in cerebrospinal fluid and pus specimens. Given the suspicion of an odontogenic source of infection, she was referred to our department. Clinical examination revealed poor oral hygiene and multiple carious teeth. Imaging studies showed a lesion centered on the mandibular right first molar extending into the mandibular canal. Since no bacterial infection was detected in the heart or lungs, she was diagnosed with a brain abscess secondary to apical periodontitis. Consequently, the mandibular right first molar was extracted, and Gram-positive bacilli were detected in the extraction socket. She was discharged without recurrence.

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Dipeptidyl peptidase-4 （DPP-4） inhibitors are widely used as oral drugs for type 2 diabetes mellitus, and autoimmune-related events have been reported infrequently. We report a case of DPP-4 inhibitor-associated bullous pemphigoid that was diagnosed after extensive oral lesions. The patient was a 68-year-old man. Two weeks before his initial visit, he developed pain and erosions over the entire oral mucosa. The patient’s symptoms did not improve despite close examination and treatment at the Department of Internal Medicine and the nearby Otorhinolaryngology Department. At the time of initial examination, erosions around the right pinky fingernail and blisters and erosions on the bilateral buccal and palatopharyngeal mucosa were observed. Anti-BP180 antibody was positive. Biopsy of the oral mucosa revealed subepithelial connective tissue blister formation. Direct fluorescent antibody analysis revealed linear deposition of IgG and C3 in the basement membrane. Suspecting a possible association with DPP-4 inhibitors, we discontinued the drug, and the oral blisters and erosions disappeared within about a week. When blisters and erosions are observed in the oral cavity in patients taking DPP-4 inhibitors, DPP-4 inhibitor-associated bullous pemphigoid should be suspected, and close examination and treatment should be conducted.

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Pulmonary thromboembolism （PTE） is a life-threatening condition that occurs when a pulmonary artery becomes obstructed, with approximately 90％ of embolic sources originating from deep vein thrombosis （DVT） in the lower limbs or pelvis. Since PTE and DVT represent a continuum of the same pathological process, they are collectively referred to as venous thromboembolism （VTE）. The patient was a 46-year-old man who developed respiratory failure after undergoing an incision and drainage procedure for buccal cellulitis, suspected to have resulted from extraction of the maxillary third molar. Despite receiving oxygen therapy, his respiratory distress did not improve. Chest CT and blood tests confirmed a diagnosis of PTE. Continuous heparin infusion and edoxaban therapy were initiated, leading to symptom relief.

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