Right upper lobe intrapulmonary mature cystic teratoma. An unusual location with unusual associations and a review of the literature.

INTRODUCTION: Teratomas are rare neoplasms made up of mature embryonic germ cell layers. Extra-gonadal teratomas are rare and primarily in the mediastinum. Mature cystic teratomas (MCT) are slow-growing benign tumors accounting for a small number of mediastinal germ cell tumors. Patients with MCT are often asymptomatic, and even most symptomatic intrapulmonary teratomas present with vague and non-specific symptoms such as cough, hemoptysis, and chest pain. CASE PRESENTATION AND DISCUSSION: A Yemeni patient presented for two years with dry cough, shortness of breath, and stitching right-sided chest pain. Plain X-ray showed pleural thickening associated with two opacities in the right lung- one located centrally in the upper lobe and another peripherally- which were confirmed with a CT scan. During right-sided decortication with resection of the two masses, extensive adhesions were found between the right pleura and the chest wall. The adhesions were released, and right-sided decortication led to the removal of the peripheral cystic mass attached to the pleura. Histopathology reported the presence of squamous epithelium lining with ectodermal components such as hair follicles, sebaceous glands, keratin debris, fatty, and fibromuscular tissue. CONCLUSION: Intrapulmonary teratomas are rare tumors, with less than 100 cases reported in the past few years. All the reported cases are in the left lung lobes, yet our case is on the right side. Although the right-sided mature cystic teratoma is even scarcer, physicians should have a high index of suspicion for teratoma when encountering abnormal lesion in the right side of the lung confirming it either by CT or MRI.

Ewingella americana Peritonitis in a Patient on Peritoneal Dialysis: A Case Report and Review of the Literature.

Most episodes of peritoneal dialysis (PD)-associated peritonitis are caused by skin-dwelling gram-positive bacteria and gram-negative bacteria colonizing gut and urinary tract. Occasionally, however, uncommon bacteria can cause peritonitis in PD patients. We describe a case of Ewingella americana peritonitis, the first such case reported from the United States. A 68-year-old woman with end-stage kidney disease due to hypertension was initiated on PD 2 years prior to the present event. She presented with abdominal pain associated with nausea and vomiting. She was afebrile and hemodynamically stable. Abdomen was diffusely tender with guarding and rebound. No obvious root cause was apparent. Initial PD fluid white count was 502/mm3 with 87% neutrophils. Gram stain was negative. Culture grew gram-negative rods, which were later identified as Ewingella americana, resistant to ampicillin and cefazolin but sensitive to gentamicin, ceftazidime, and cefepime. After empiric intraperitoneal vancomycin and gentamicin, she was continued on intraperitoneal gentamicin for a total period of 21 days. She responded to the treatment rapidly with complete recovery. PD fluid on day four showed 40 nucleated cells with 12% neutrophils. Patient remained on PD without consequences. Ewingella americana is a gram-negative facultative anaerobic bacillus that can survive in water, including domestic water. Inadequate hand hygiene is a potential root cause of infection. Although rare, Ewingella peritonitis can be observed in PD patients and is treatable. Clinicians should be aware of Ewingella as a potential cause of PD peritonitis.

An Atypical Presentation of Formic Acid Poisoning.

Although formic acid (FA) poisoning is rare, it is usually fatal. Many FA poisoning cases commonly involve rubber plantation workers in which these workers ingest FA accidentally or with suicidal intentions. This is a case presentation of FA poisoning by a 73-year-old man. Additionally, the patient's old age likely contributed to his severe prognosis.