stools. Laboratory work is significant for hematocrit of 30. Remaining labs are all normal. Colonoscopy was performed which revealed a large, irreg- ular, friable mass in the cecum. Abdominal CT scan showed 6  7  7cm mass with extramural extension. No metastasis or lymph node involvement was noted on CT scan or on chest x-ray. Biopsy done at the time of colonoscopy was diagnostic for B cell lymphoma-large cell type. Patient was referred to oncology and surgery and is currently awaiting treatment. Discussion: This patient has primary colonic lymphoma. Diagnostic cri- teria for primary gastrointestinal lymphoma includes: no palpable lymph- adenopathy, normal chest x-ray, normal white cell count, predominance of bowel lesions, and no liver or splenic disease. Less than 0.5% of all colonic neoplasms are lymphomas. They develop in 50 –70 year olds with a 2 to 1 male predominance. Risk factors are usually not present but include in- flammatory bowel disease, HIV, or immunosuppression. Patients present most often with abdominal pain, hematochezia, abdominal mass, or change in bowel habitus. Cecum is the most common site (52%) followed in order by the rectum, right colon, left colon, and transverse colon. 10 –25% are multi-focal. Diagnosis may be best with endoscopy and biopsy. Based on data for gastric lymphoma, this may be 80 –90% diagnostic. There are multiple classification systems-most recent one is the REAL system. The 5 year survival rate is 35%. Prognosis is worst with size 5 cm, lymph node involvement, and increased stage. Ann Arbor staging system is often used but an alternative system was propsed at an international workshop in 1994: I-tumor confined to GI tract, II- extends to abdomen, II 1 - local lymph node involvement, II 2 -distant node involvement, II E -involves adjacent organs, IV-disseminated disease. Evaluation involves colonoscopy with biopsy, CXR, CT scan, and bone marrow biopsy. Retrospective studies show that surgery may be the treatment of choice with adjuvant therapy for residual disease. Chemotherapy alone can be used with disseminated disease. Pri- mary radiation alone is an alternative with stage I disease. 584 A case of recurrent abdominal pain Sreekanth Chandrupatla M.D., Robert Schoen M.D. University of Pittsburgh Medical Center, Pittsburgh, PA. Patient is a 28 year-old woman with no significant medical history who now presents with her fifth episode of abdominal pain. Episodes began over the previous eight months and consist of a dull, non-specific pain in the lower abdomen which typically lasts over 2– 4 days. Previous evaluations of the patient, including radiological studies and blood chemistries, were all done after pain had resolved and resulted in no significant results. At this episode, pain similar to previous episodes developed the day prior to presentation and was still present at the time of evaluation. Physical examination was significant for mild tenderness in the right lower quadrant with deep palpation. A CT scan of the abdomen and pelvis revealed appendiceal wall thickening and peri-appendiceal fat infiltration-consistent with appendicitis. Laparoscopic appendectomy was performed. Gross and pathologic evaluation revealed changes consistent with acute appendicitis. In follow-up, the patient has had no further episodes of abdominal pain. Discussion: Appendicitis is a very common disease with 250,000 cases per year. It usually presents with acute onset which resolves with appendec- tomy. Recurrent appendicitis is a variant where patients develop short episodes of pain which resolve completely between episodes. Based on retrospective studies, recurrent appendicitis is seen in 10 –20% of all cases of appendicitis. The symptoms tend to be less severe than acute appendi- citis and resolve within 2–3 days. The pathophysiology involves the initial development of an obstruction of the appendiceal lumen with a fecalith, lymphoid hyperplasia, or a foreign body. This leads to luminal distension and subsequent development of visceral pain. In acute appendicitis this can eventually perforate. In recurrent appendicitis, however, the pressure over- comes the obstruction and the lumen drains with resolution of symptoms. Diagnosis is best during episode of pain. CT scan may be the best diag- nostic test with 95% sensitivity and specificity in acute appendicitis. Abdominal ultrasound and barium enemas are alternatives. Rate of recur- rence is 38% in all patients. Between pain episodes, recurrent appendicitis can not be diagnosed because the appendix returns too normal. At this stage, other etiologies need to be ruled out. Recurrent appendicitis should be kept on the differential and considered when symptoms recur. Surgery is therapeutic and prevents recurrence of symptoms. 585 Disseminated Cryptococcus neoformans in a cirrhotic patient A. Chaudhary*, A Gurakar, S. Rashwan, A. Sebastian, A. Aly, J. Hudson, H. Wright, B. Nour. Nazih Zuhdi Transplantation Institute, Integris Baptist Medical Center and *Department of Gastroenterology, Medical College of Georgia, Augusta, Georgia 70912. Cryptococcus Neoformans is prevalent worldwide. It rarely causes dissem- inated infection and majority of cryptococcus infection occurs among patients with immunocompromised states, (i.e. AIDS, organ transplanta- tion, malignancy, and sarcodosis patients on steroid treatment). We hereby report a case of a fifty-four year-old caucasian male who was diagnosed with disseminated cryptococcus neoformans in a setting of newly diagnosed cirrhosis, resulting in acute decompansation of the dis- ease, leading his demise. During the summer of 2000, the patient was diagnosed with liver cirrhosis by his local physician. His family history consisted of question- able diagnosis of cirrhosis with his father and the patient was eventually told he might have hemachromatosis, due to skin discoloration and high ferritin levels. In mid January 2001, the patient started complaining of dyspnea, fatigue, weakness and later had developed edema, jaundice, coapulopathy, and renal insufficiency. Eventually, the decision was made to refer the patient for liver transplant consideration, from his home town in northern Arkansas. Upon admission to the liver intensive care unit, the patient immediately needed to be intubated because of his anascara state causing respiratory compromise. In view of the end-stage nature of his liver disease, liver transplant workup had been initiated. His vital signs upon admission were as follows: blood pressure 86/33 mm/Hg. heart rate 139/m: room air oxygen saturation was 80%, weight 145 kg, height 5'8. A physical exam revealed temporal wasting, decreased breath sounds on both lung fields, abdomen with large ascites and extrem- ities showing evidence of three to four edema. His condition has somewhat improved after fluid resuscitation, and albumin infusion. Initial labs, showed bilirubin of 5.4mg/dl serum, albumin 2.2g/dl, ALT 54u/l, fibrino- gea 162 mg/dl, Protime 42.1 seconds with INR of 4.23, platelet count 144,000/mm 3 , white count 29,500/mm 3 , potassium 6.2 mg/l, creatine 4.6 mg/dl, BUN 63 mg/dl, ammonia 84 umol/l. His iron studies consisted of: iron 27 mg/dl, total iron binding capacity 126 mcg/dl and iron saturation 21%, ferritin 1300 ng/ml. His Hepatitis B surface antigen and Hepatitis C antibody were negative. By the next day his HIV, HTLV were negative, toxoplasma titers, rubella titers, CMV IGM, Herpes type I and II were all noted to be negative. However, serum cryptococcal antigen reported as positive at 1:512 titer. Sputum cultures were positive for yeast with pseudohypea. Ascitic fluid was with evidence of peritonitis, with 38, 070 WBC, (74% polymorphs). At one point the AST was increased as high as 7,519, and ALT up to 1983 u/l. Because of the positive cryptococcal antigen in the serum, treatment with amphotericin B Lipid Complex was initiated. Medical management had been maximized with continuos venous venous hemodialysis. Of impor- tance, the ascitic fluid cultures were reported as positive for encapsulated yeast by india ink prep, consisting with cryptococcal peritonitis. Because of the evidence of active cryptococcal infection, liver trans- plantation has been considered as an absolute contraindication and decision was made to halt the liver transplant evaluation and to continue with maximum medical treatment. The patient’s condition continued to decline rapidly and in spite of the appropriate antibiotic coverage, the patient expired 48 hours after being admitted to the intensive care unit. One week later, both his initial blood cultures and ascitic fluid cultures were reported as positive for cryptococcus neoformans, coinciding with disseminated cryptococcal infection. S185 AJG – September, Suppl., 2001 Abstracts