Tyrosinemia type III is the rarest type of tyrosinemia, because of a mutation in 4-OH-phenylpyruvate dioxygenase (HPD). This causes two different types of diseases with different modes of inheritance: tyrosinemia type III and hawkinsinuria. Hawkinsinuria is an autosomal dominant disease, which presents a failure to thrive and metabolic acidosis; however, the liver is not affected. P.A33T heterozygous mutation was reported by Tomoeda et al. to cause hawkinsinuria. This case report will present the first case of an Egyptian-Lebanese male who developed direct hyperbilirubinemia and was found to have tyrosinemia type III, due to elevated tyrosine levels in the blood and tyrosine derivatives in the urine, but genetic testing revealed a P.A33T heterozygous mutation, a cause of hawkinsinuria.

Disposal of fetal remains as a biohazard material after spontaneous abortion has been the standard practice in many states across the United States of America. In certain states, when a patient requests the fetal remains, it raises a controversy. A proper funeral and burial may be beneficial for patients who suffered from a miscarriage. A patient who is informed of the options available to her after a miscarriage can then decide the most suitable path to deal with such a tragedy. However, the return of the fetal remains to the patient still remains a controversy in certain locations.