He went home with hospice services

He went home with hospice services. Discussion: Primary effusion lymphoma is a human herpesvirus 8-associated B-cell lymphoma originally reported in human immunodeficiency virus-positive patients. loss and worsening fatigue. The above complaints on initial evaluation prompted testing for human immunodeficiency virus (HIV) that returned as positive. On physical examination, the patient’s vital signs were unremarkable. He was cachectic and ill-appearing. He had no lymphadenopathy or thrush or tonsillar exudates present, but he had hyperpigmented lesions across the hard palate. His abdomen was soft and tender to palpation diffusely. Admission laboratory workup showed a positive HIV screen, with a reflex CD4 of 33 cells/mm3 and a viral load of 5.65 log5. A cryptosporidial stool study was positive. During the patient’s hospital course, nitazoxanide was initiated for treatment of cryptosporidiosis, and he was initiated on antiretroviral therapy (ART) in the setting of opportunistic infection and critically-low CD4 count. On hospital day 6, the patient began to complain of increased vomiting that was refractory to antiemetic therapy. An esophagogastroduodenoscopy showed biopsy-positive cryptosporidiosis and immunoglobulin G cytomegalovirus positivity. Nausea and vomiting both increased in severity. On hospital day 16, noncontrast CT of the abdomen and pelvis revealed a small bowel intussusception measuring 10 cm. This finding was reduced in the operating room, with gross pathology unremarkable for any structural lesions. The patient was gradually returned to and tolerated a regular diet and was discharged 2-weeks Acrizanib postoperatively. Discussion: There have been no documented cases of cryptosporidiosis having caused intussusception. Intussusception is believed to account for only 1% of all intestinal obstruction in adults, and only 5% of all documented intussusceptions occur in the adult population. Structural lesions such as polyps, cystic fibrosis (with a 1% lifetime risk), vascular lesions, malignancies, and Meckel diverticulum have been previously documented culprits for intussusception in adults. Provided some of the gastric structural pathology associated with intestinal cryptosporidiosis in immunocompromised models, the proximal lead point for this intussusception was likely caused by some structural abnormality not fully visualized intraoperatively or upon pathological examination of specimens retrieved. The presentation of intussusception varies dramatically, lasting anywhere from 6 hours to 3 years. Prior to obtaining advanced abdominal imaging, our patient experienced approximately 10 days of nausea and vomiting, both not unusual Acrizanib in the setting of cryptosporidiosis in a severely immunocompromised patient. This effectively mimicked what were in fact obstructive symptoms. In the setting of small bowel obstruction, pooled estimates have placed average-slice-width CT at 87% sensitivity and 81% specificity. Prior to the imaging result, continued nausea and vomiting likely signaled either failure of nitazoxanide therapy or new gastroenterological pathology. Conclusion: Cryptosporidial Rabbit Polyclonal to ZP4 intestinal pathology may serve as a lead Acrizanib point for small bowel intussusception. The timing of advanced abdominal imaging retrieval in the setting of intractable nausea and vomiting remains debated between both radiologists and hospitalists. 7 Chronic Lymphocytic Leukemia Transformed to Philadelphia Chromosome Positive Precursor B-Cell Acute Lymphoblastic Leukemia: A Case Report Abdulaziz U. Joury, MD; Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, Yevgeniya Foster, MD; Department of Medicine, Duke University, Durham, NC, Metin Ozdemirli, MD; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, Khaled el-Shami, MD, PhD; Division of Hematology and Oncology, George Washington University, Washington, DC Case Presentation: A 62-year-old African American female was initially diagnosed with chronic lymphocytic leukemia in 2004 that transformed 4 years later to Philadelphia chromosome positive precursor B-cell acute lymphoblastic leukemia (Ph+ pre-B ALL). Reverse transcription polymerase chain reaction (rt-PCR) was positive for clonal rearrangement of immunoglobulin heavy chain gene as well as the presence of p190 BCR-ABL fusion transcript. The patient was treated with Acrizanib hyper-cvad regimen (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) in addition to imatinib and rituximab, achieving morphologic and complete cytogenetic remission. Six.