White sponge nevus （WSN） is a white lesion of the mucosa and has a characteristic spongy surface.
In this study, we examined the microstructural changes in cell adhesion structure using transmission electron microscopy in two cases of familial WSN and five cases of non-familial WSN. We found enlarged intercellular spaces and decreased bundles of keratin fibers adhering to the attachment plaque in all cases. Deformation and exfoliation of the desmosomes were also observed. These findings suggest that the cell-to-cell adhesion disorder mediated by desmosomes in cases of WSN may be the cause of abrasion-related lesion detachment. Furthermore, the expansion of intercellular spaces mediated by desmosomes was considered to be a common pathogenesis in both familial and non-familial WSN.

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In immunosuppressed patients, gas gangrene progresses rapidly and can be fatal. We report a case of rapidly spreading gas gangrene in a 78-year-old woman receiving prednisolone and tocilizumab for rheumatoid arthritis（RA）. The patient was found lying on the street three days after tooth extraction and was transported to our hospital by ambulance. She had marked redness and swelling from the left submandibular area to anterior neck, and stink. The patient was on prednisolone and tocilizumab for RA on a regular basis, and it was thought that the infection spread rapidly due to immunocompromise. After entering the intensive care unit, she was treated with the emergency department and other related clinical departments, and debridement was performed under general anesthesia. After 60 day hospitalization in our hospital, she was transferred to a rehabilitation center for her illness.

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The patient was a 66-year-old female who had been aware of dyspnea due to swelling in the perimandibular region for more than a month. Findings from an initial facial examination revealed diffuse swelling in the submental region with no fever or pain. The mucosa of the oral floor presented as a double tongue due to edema, and the patient was aware of respiratory distress. Ortho-panoramic radiography, cervical echocardiography, and a CT scan were negative for neoplastic lesions. Blood tests showed an eosinophil count of 1,380/ul and so an allergic reaction was suspected. Since anti-allergic drugs were not effective and there was no improvement in the clinical symptoms, we recommended the patient see an internal medicine physician. At the internal medicine department, the patient was diagnosed with idiopathic hypereosinophilic syndrome due to an eosinophil count of 2,157/ul and a bone marrow examination that was negative for leukemia. Steroid therapy quickly reduced the eosinophil count. Prolonged hypereosinophilia may cause organ damage. The present case suggests that it is necessary to keep in mind a differential diagnosis of oral and cervical swelling.

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