Newborn oropharyngeal teratomas are extremely rare disorders. Epignathus tumour is a congenital malformation characterised as a 'mature teratoma' located at the oropharyngeal region. Teratomas in the upper respiratory airway give rise to abnormal life -threatening airway obstruction during the neonatal period. It is associated with high morbidity and mortality, requiring proper and cautious planning and prompt surgery. We describe a rare case of oropharyngeal teratoma in a premature male neonate (35 weeks gestation) who presented with difficult intubation. On flexible laryngoscopy, it appeared as a large vallecular cyst, while the computed tomography scan demonstrated a posterior pharyngeal wall cystic lesion causing oropharynx narrowing. The patient was operated on 8th day postpartum. Histopathological examination was compatible with mature cystic teratoma.

PONCET DISEASE IN A PATIENT WITH SMEAR-NEGATIVE PULMONARY TUBERCULOSIS: A CASE REPORT Pulmonary tuberculosis poses a diagnostic dilemma to clinicians especially in the absence of typical presentation. The hypersensitivity to tuberculosis infection in other parts of the body can lead to nondestructive, para-infectious arthritis. This is known as Poncet disease, one of the clinical syndromes of musculoskeletal tuberculosis. Herein, we report a case of smear-negative pulmonary tuberculosis presenting with atypical features. It started with multiple joint pain, followed by the presence of multiple tender nodular skin lesions over the bilateral shins and wrist. Subsequent investigations led to the diagnosis of smear-negative pulmonary tuberculosis. Joint pain and erythema nodosum disappeared soon after antituberculosis therapy, supporting the diagnosis of Poncet disease.

Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis (PAM) that infects the central nervous system (CNS). The amoeba is present ubiquitously. The infection is rare but has a high mortality rate. The pathogenic amoeba reaches the host through the nasal passage and migrates along the olfactory nerves to reach the human brain and cause severe destruction of the CNS. As Malaysia has a large population that practising ablutions in daily routine, the risk of infection increases. Two mechanisms associated with the infection include contact-dependent and contact-independent. Signs and symptoms vary from early stage to later stage of infection. CSF and brain biopsy are the common specimens collected used to diagnose the PAM infection and usually detect and identify by PCR method. As for treatment, the CDC of United States America has recommended the usage of miltefosine that provides promising in vitro therapy against N. fowleri. This review will discuss more on the occurrence of N. fowleri, pathogenicity, diagnostic tools, and pharmacotherapy approach against N. fowleri infection.