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Acute exacerbation of chronic hepatitis C (HCV) in two elderlypatientsPolish RD, Holtzmuller KC, Sjogren MH. Walter Reed Army MedicalCenter, Washington, DC.

HCV is known for its slow indolent course. We present two elderly patientswho experienced severe exacerbation of their chronic HCV. In both casesan extensive evaluation to rule out other causes of their acute hepatitis,which included drugs was negative. Case #1: 78 y/o WM with HCV fromblood transfusion during CABG in 1985. He remained asymptomatic untilhe presented with 10# wt. loss, fatigue and acute transaminitis. Liver bxshowed severe inflammatory activity, and portal and focal bridging fibrosis.Interferon �-2b(IFN) was initiated. He normalized his transaminases within4 wks and his HCV RNA became NEG. After a total of 12 weeks of IFNhe remains HCV RNA negative

AST ALT A.P. T.B.

4/9/99 41 52 92 0.52/13/01 1134 1236 172 4.33/7/01 30 40 111 0.95/16/01 25 25 82 0.5

Case #2 76 y/o male with HCV from a blood transfusion during CABG in1979. He remained asymptomatic until he developed an acute sustained risein transaminases. Liver bx. showed moderate inflammation and minimalfibrosis. IFN was initiated with prompt resolution of transaminitis. RNArelapsed after cessation of tx but ALT remains normal. IFN therapy wascomplicated by atrial fibrillation.

AST ALT A.P. T.B.

10/8/95 420 840 123 1.32/26/96 646 921 108 1.24/1/96 52 103 69 1.03/1/01 39 38 68 1.1

Reactivation of hepatitis C causing an acute hepatitis is rare, we present twoelderly patients with acute rise in ALT, both had a prompt response to IFN.HCV is a reported cause of acute hepatitis in the elderly. However there areno cases reported of severe exacerbation of chronic HCV in this population.Conclusion: acute exacerbation of chronic HCV in the elderly can occurand responds to IFN.

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Parvovirus B19 infection presenting as acute hepatitis andpancytopeniaJeffrey Poole M.D.1 and John Dibaise M.D.1*. 1InternalMedicine/Gastroenterology, University of Nebraska Medical Center,Omaha, Nebraska, United States.

Purpose: A 73-year-old man presented with complaints of fevers, chillsand abdominal discomfort for two weeks and decreased urine output for 24hours.Methods: He had not been feeling well for 2 months and had lost approx-imately 20 lbs. This was thought to be secondary to sinusitis but he had notresponded to several courses of antibiotics. Medications were Rhinocort,Levaquin and Pepcid. Past medical history was significant for RheumaticFever and self-limited colitis 20 years previously. Physical Exam wasremarkable only for a blood pressure of 87/48. His abdomen was benignand there was no asterixis. Initial evaluation revealed alkaline phosphatase1282, AST 541, ALT 552, Albumin 1.6, T-Bill. 2.5, PT 12.3, CBC showedWBC 2.2, HGB 8.6, HCT 25.1, 38 Platelets 89, and Bands 21%. AnUltrasound revealed gallbladder sludge and an abdominal CT scan dem-onstrated only a small amount of pericholecystic fluid. HIDA scan wasnormal. Blood cultures were negative. Due to worsening pancytopenia, a

bone marrow examination was performed and was remarkable for hypo-plastic bone marrow and absent iron stores. HIV, EBV, Hepatitis A, B andC, CMV, Herpes, Blastomyces, Anti mitochondrial AB, Q fever, BrucellaAB, Liver kidney microsome AB, leptopira antibody, Lyme AB, Smoothmuscle AB, Histoplasma AB, Tularensis AB were negative. Serum Par-vovirus B19 IgG was 3.18 (normal �0.8) but IgM was normal. Hiscondition progressively deteriorated despite aggressive support. Due todevelopment of coagulopathy a transjugular liver biopsy was performedand showed features of steatohepatitis with mild patchy and mild centri-lobular necrosis. Several hours after the biopsy he developed a rigidabdomen along with hypotension. An abdominal CT scan revealed in-creased ascites consistent with hemorrhage with a large psoas hematomaand a focus of high attenuation consistent with active hemorrhage from theright lobe of the liver.Results: Despite aggressive resuscitation and support his condition dete-riorated. His family decided to withdraw further support. Soon thereafterthe patient died. An autopsy was performed confirming fatal hemorrhage asthe cause of death. DNA amplification of a liver sample as well as thepremortem liver biopsy revealed Parvovirus infection.Conclusions: This report describes a very unusual complication of acommon infectious disorder. It brings awareness to the potential cata-strophic complication resulting from liver biopsy, even when a transjugularapproach is utilized.

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A rare case of sporadic Burkitt’s type primary small bowellymphoma without extranodal involvementRaaj K.Popli, MD and Martin E. Avalos, MD., FACG. Division ofDigestive Diseases and Nutrition, VA Medical Center and University ofSouth Florida. College of Medicine, Tampa, Florida.

Burkitt’s Lymphoma is a very aggressive, high grade, small non-cleavedmalignant lymphoma that arises from B lymphocytes. It is classified asendemic type (more common in Africa) and non-endemic or sporadic type(more common in the Western world). Endemic type cases are character-ized by jaw tumors, followed by involvement of kidneys, retroperitoneum,CNS, gonads, and breast. Sporadic type cases are characterized by abdom-inal and/or pelvic visceral and pleuropulmonary lymph node involvement.The ileocecal area is often massively infiltrated and affected patients areusually young in their second or third decade of life with a male/femaleratio of 3:1. While lymphomas account for approximately 15% of smallbowel tumors, primary gastrointestinal lymphomas in general account foronly 5% of all lymphomas. There are only a few cases reported of sporadic,Burkitt’s type primary lymphoma involving the small bowel. We presentthe case of a 64-year-old Caucasian male who had a 4 to 5 day history ofabdominal bloating and nausea. Abdominal X-rays revealed findings of asmall bowel obstruction. A CT scan showed thickened small bowel mucosain the area close to the ileum. During colonoscopy the terminal ileum wasintubated showing a narrowed lumen with hardened, infiltrative mucosawith a “cobble stone” pattern. Biopsies revealed a high-grade B celllymphoma with a characteristic “starry sky pattern” highly suggestive ofBurkitt’s type lymphoma. The patient underwent small bowel resectionwith intraoperative staging. Surgical margins were free of tumor as well asthe regional mesenteric lymph nodes that were resected. A liver biopsy didnot show lymphoma involvement. Further postoperative staging included abone marrow examination as well as lumbar puncture and CT scans of thehead, chest, abdomen and pelvis. None of them showed lymphadenopathyor lymphoma involvement. A final diagnosis of primary Burkitt’s typelymphoma of the small bowel was made. The patient is currently receivingadjuvant chemotherapy. This case illustrates a rare case of primary smallbowel non-endemic Burkitt’s type lymphoma. Radiological, endoscopicand histological documentation is provided.

S234 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001