management strategy is variable, illustrating the importance of addressing underlying thrombotic risk factors and consideration of both atypical
causes and anatomical factors in evaluating and managing DVT in women with unusual symptoms and other hematologic conditions.
VISCERAL KAPOSI SARCOMA PRESENTING AS ORAL PAIN Nicholas LeBlanc, Melody Salmanian, Tiffany Ardoin; Louisiana State University, Baton Rouge, LA.
Introduction: Kaposi Sarcoma (KS) is an opportunistic vascular malignancy associated with infection by human herpesvirus 8 (HHV-8) commonly seen in patients with poorly controlled HIV and AIDs with CD4 counts of less than 200 cells/mm3. Although it classically presents with hyperpigmented, violaceous skin nodules, patients can also demonstrate mucosal lesions as well as pulmonary, gastrointestinal, hepatic, bone, and lymph node involvement making the diagnosis sometimes more difficult in those without cutaneous findings. Case: A 36-year-old male with HIV/AIDs (diagnosed 2013, VL 1.36 million copies/mL, CD4 36 cells/mm3) and nonadherence with antiretroviral therapy (ART) presented with 2 weeks of worsening dental/ oral pain, extensive gingival and oral mucosal swelling, and odynophagia. Initial physical exam revealed recession of the gums, extensive dental plaques, as well as gingival and mucosal swelling with distinct areas of hyperpigmentation and violaceous nodularity most notable on the hard and soft palate. The CT of the soft tissue neck revealed reticulonodular apical pulmonary opacities, but the patient did not have any pulmonary symptoms. Infectious Disease (ID) was consulted due to a concern
for Kaposi Sarcoma in the setting of uncontrolled HIV/AIDS. Laboratory workup for opportunistic infections including Bartonella serologies, Histoplasma urine antigen, Blastomyces Antigen, Cryptococcal Antigen, Fungitell, and AFB sputum and blood cultures were all negative. ID subsequently re-initiated ART for immune reconstitution, and otolaryngology performed a biopsy of the hard palate with findings consistent with Visceral Kaposi Sarcoma including vascular proliferation with slit-like vessels and hyperchromatic spindled endothelial cells with IHC staining positive for HHV-8. The patient was ultimately evaluated by Oncology and initiated on treatment with Liposomal Doxorubicin. Unfortunately, he developed immune reconstitution inflammatory syndrome (IRIS) and acute hypoxemic respiratory failure related to pulmonary involvement of his KS and IRIS and died two months later. Discussion: This case illustrates a unique presentation of a classic but rare AIDs-defining malignancy with the chief complaint of dental/oral pain. Although he did not have skin involvement, KS was the underlying diagnosis with associated complications ultimately taking his life.
WHEN PREVENTION PROVOKES: UNEXPLAINED PANCREATITIS IN A PREP USER Asad Mussarat, Charlie Woodall, Rasha Kako, Thomas Cranfill, Michael Modica; Louisiana State University, New Orleans, LA.
Introduction: Acute pancreatitis is an inflammatory condition that results from various etiologies, including gallstones, alcohol use, hypertriglyceridemia, and certain medications. In some cases, medications like antiretroviral therapy, particularly those used in Human Immunodeficiency Virus (HIV) prevention or treatment, can contribute to the development of pancreatitis.
Case: A 43-year-old male with no significant past medical history presented for 1 day of nausea, vomiting, and epigastric pain. His symptoms were triggered when ingesting liquids and unspecific solid foods. He denies alcohol use for the past 7 years and denied biliary disease in the past. His only medication was emtricitabine/tenofovir alafenamide, which he was taking for HIV pre- exposure prophylaxis for over a year. On physical 60
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