INFECTED MEDIASTINAL MATURE TERATOMA

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mature teratoma, a benign germ-cell tumor, commonly presents in ovaries. Extragonadal manifestation is uncommon and rarely occurs with superimposed infection. We present unique case extragonadal teratoma found mediastinum complicated by CASE PRESENTATION: A 24-year-old male history asthma presented 3-day dyspnea right rib pain radiating into center his chest. He reported 30-pound weight loss preceding 3 months. denied tobacco, alcohol, or recreational drug use. previously worked as coal miner but now working coastal drilling. was afebrile normotensive had an oxygen saturation 93% on room air. On examination, he upper lobe rhonchi absent breath sounds basilar region. Chest imaging showed complete collapse middle lower lobes, large loculated pleural effusion within anterior lung base, heterogeneity rim enhancing fluid collection, which suggestive empyema. The patient leukocytosis 16.6k neutrophil predominance 14.18k. started empiric intravenous antibiotics vancomycin, ceftriaxone, metronidazole. underwent video-assisted thoracoscopic surgery cystic mass resection from pericardial surface lobe, 1600 milliliters purulent drainage, decortication lobes. Frozen section squamous glandular cells. Pathology keratinized skin granulation tissue, acute chronic inflammation, giant cell reaction consistent infected mature teratoma. Pleural fluid's gram stain revealed 2+ PMNs no growth aerobic, anerobic, fungus, AFB cultures. de-escalated to amoxicillin-clavulanate for 14-day course clinically improved. DISCUSSION: This demonstrates rare presentation mediastinum. Mediastinal teratomas occur 20 40 years old clinical symptoms cough, chest pain, trichoptysis, fever. Possible complications are infection, rupture, malignant transformation, paraneoplastic anti-N-methyl-D-aspartate receptor (anti-NMDA receptor) associated limbic encephalitis. Infected uncommon. Reported infectious organisms include Salmonella enterica, Escherichia coli, Mycoplasma pneumonia, Staphylococcus aureus, agalactiae, Haemophilus influenza. Proposed pathogenesis due release proteolytic enzymes pancreatic and/or intestinal mucosal tissues tumor leading inflammation eventual CONCLUSIONS: Teratoma may be rupture. Definitive management surgical excision antibiotic targeting organism. REFERENCE #1: Lee WL, Yen MS, Tseng JY, Yu KW, Wang PH. secondary infection: report. Changgeng Yi Xue Za Zhi. 1999 Jun;22(2):339-43. PMID: 10493045. #2: Li C, Lin F, Liu Hai Y, L. Intrapulmonary misdiagnosed aspergilloma. Thorac Cancer. 2018;9(2):328-329. doi:10.1111/1759-7714.12566 #3: Tian Z, H, S, et al. Surgical treatment mediastinal teratoma: summary experience 108 cases. J Cardiothorac Surg. 2020;15(1):36. Published 2020 Feb 17. doi:10.1186/s13019-020-1075- DISCLOSURES: No relevant relationships Ashley Anselene, source=Web Response Asma Balobaid, Shu Xian Lee, Rebecca Reece,