(580) Disseminated Yersinia Enterocolitica after Orthotopic Heart Transplant

IntroductionThere have been only modest improvements in the 90% survival rate at one year after heart transplantation since 1990s. This is largely due to antibody mediated rejection, cardiac allograft vasculopathy, malignancy, and immunosuppressive complications such as infection. Here, we present a case of disseminated Yersinia four years orthotopic transplant.Case ReportA 68 old gentleman with ischemic cardiomyopathy status-post transplant (CMV D+/R-) on cellcept tacrolimus presented several weeks abdominal pain. Abdominal CT demonstrated an irregular, eccentric mass hepatic flexure, circumferential bowel wall thickening, prominent mesenteric adenopathy. Colonoscopy revealed severe colonic ulceration. Biopsies colitis fibrinopurulent exudate concerning for infectious versus cellcept-induced colitis. Cellcept was discontinued azathioprine started without symptomatic improvement. MRI multiple lesions, prompting CT-guided biopsy which positive enterocolitica. The patient's well water suspected be source. Ceftriaxone ciprofloxacin were started. After biopsy, he developed hypotension required intubation vasopressor support. Due pancytopenia, resumed but overall regimen decreased setting Yersinia. Initially, his clinical status precluded endomyocardial biopsy. Immunosuppressive levels monitored by ImmuKnow assay, quantifies T-cell immune function. Once recovered, performed 1R. patient completed 14 months serial scans two subsequent colonoscopies. He has had no recurrence.SummaryHeart recipients are increased risk infection therapy. Here rare Yersinia, likely contaminated water. There transplant. A recurrence. Heart