is overwhelmingly a disease of immunocompromised patients, it can occur in immunocompetent hosts, and delay in diagnosis and treatment can lead to adverse and fatal outcomes. This patient had no known underlying conditions
besides a recent mild COVID-19 infection and underlying Chiari I malformation, neither of which are known to be associated with cryptococcal meningoencephalitis. These factors may however have played a role in his disease and progression.
CHRONIC LYMPHOCYTIC LEUKEMIA DISGUISED AS CHOLECYSTITIS Austin Bordelon, James Bordelon, Jr; Edward Via College of Osteopathic Medicine - Louisiana Campus, Monroe, LA.
Introduction: Infiltration of the gallbladder by lymphoma is a rare discovery, and as cases are continuing to be published, it should be considered in the differential diagnosis for right upper quadrant pain.
differential again showed significant lymphocytosis with neutropenia. CT with contrast showed multifocal lymphadenopathy and a diffusely thickened stomach wall. A diagnostic esophagogastroduodenoscopy with biopsy was performed. Pathology of the specimens showed Helicobacter pylori organisms in the antrum of the stomach and florid chronic active gastritis of the fundus of the stomach. Flow cytometric immunophenotyping confirmed the diagnosis of chronic lymphocytic leukemia/ small lymphocytic lymphoma. Triple therapy of amoxicillin, clarithromycin, and omeprazole was initiated. Hematology/oncology was consulted and additional labs and a PET/ CT scan were ordered; results are pending. Discussion: This case illustrates the potential for chronic lymphocytic leukemia to arise in the gallbladder and mimic a cholecystitis- like presentation. Consideration of chronic lymphocytic leukemia with this presentation may evolve the differential diagnosis for right upper quadrant pain as well as promote studies for medical treatment and surgical indication.
Case: A 70-year-old woman consulted her primary care physician for right upper quadrant abdominal pain, occasional nausea, and infrequent vomiting for 3 months. Her physical exam was unremarkable with no tenderness to palpation of the abdomen and no rebound or guarding. Abdominal ultrasound showed sludge and adenomatosis with a sonographic Murphy’s sign. General surgery was consulted, and six weeks later an elective cholecystectomy was performed. Preoperative complete blood count with auto-differential showed significant lymphocytosis with neutropenia. Pathology reported the gallbladder had a very thickened wall composed of a dense lymphocytic infiltrate. A working diagnosis of chronic lymphocytic leukemia/ small cell lymphoma was made. At her one-week follow-up, the patient reported malaise but denied any pain or other post-operative complaints. Repeat CBC with auto-
LATE ONSET IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME FOLLOWING CRYPTOCOCCAL MENINGITIS Yasmeen Kawji, Jacob A. Nelson, Carl J. Giffin, Alexander G. Hosse; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Immune reconstitution inflammatory syndrome (IRIS) refers to a paradoxical worsening of manifestations of a preexisting infectious disease or the unmasking of an occult infectious disease after initiation of antiretroviral therapy (ART). For IRIS presenting after cryptococcal meningitis, symptoms resemble those of meningitis and typically occurs within the first few months after initiation of ART. We report a case of IRIS occurring 8 months after ART initiation presenting with symptoms resembling recurrence of the patient’s cryptococcal meningitis.
9 months after diagnosis of cryptococcal meningitis, for which he remained on maintenance therapy with fluconazole after he had completed induction therapy with Amphotericin B and consolidation therapy. It had been 8 months since the initiation of ART when he presented to the emergency department with headache, photophobia, ataxia, and gait instability. The patient reported adherence to ARTs and fluconazole, and recent labs revealed an undetectable HIV viral load and a CD4 count of 143 (improved from 4). MRI of the brain revealed diffuse leptomeningeal enhancement consistent with cryptococcal meningitis. Lumbar puncture 46
Case: A 35-year-old African American male presented
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