SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Immunosuppression after transplantation is known to be associated with an increased risk of opportunistic infections, most commonly bacterial and viral infections. An increasing number of parasitic infections have been identified in transplant patients. CASE PRESENTATION: This is a case of a 69 year-old Indian male, former smoker, with a past medical history notable for interstitial lung disease of unclear etiology, latent TB, sarcoidosis, and chronic hypoxic failure who underwent bilateral lung transplant (CMV D+/R+ EBV D+/R+). Three days after transplant, the patient began having multiple loose bowel movements. A GI pathogen PCR returned positive for vibrio (non-cholera) and giardia for which the patient was treated with a 7 day course of metronidazole and minocycline. A repeat GI pathogen PCR one week later was negative. DISCUSSION: Solid-organ transplant recipients may acquire parasitic diseases through travel to endemic areas, transmission within the graft, de-novo infection, or activation of dormant infection due to immunosuppression (1). A study of 124 renal transplant patients with chronic diarrhea over a 6 month period found that giardia was the most common organism isolated (n= 37 patients, 29.8%) followed by cryptosporidium (n = 36, 29%) (2). In 2016, the first case of intestinal giardia lamblia transmission following a simultaneous pancreas and kidney transplantation was documented. The infection was localized in donor and recipient duodenal tissue about 2 months after transplantation, and the case was thought to most likely represent transfection at time of transplantation (3). CONCLUSIONS: Persistent diarrhea after solid organ transplantation occurs in up to 20% of patients. Since it can affect the patient’s quality of life and potentially cause malnutrition, early identification and treatment of the causative organism is imperative (3). This is the first case of giardial infection, likely re-activation, found in a lung transplant recipient and highlights the importance of considering country of origin and exposures when evaluating for infectious etiologies in lung transplant patients. Reference #1: 1. Forrest, G. (2004). Gastrointestinal infections in immunocompromised hosts. Current Opinion in Gastroenterology, 20(1), 16-21. https://doi.org/10.1097/00001574-200401000-00005 Reference #2: 2. Shad, S., Hanif, F., Haq, M. U., Luck, N. H., Aziz, T., & Mubarak, M. (2019). Frequencies of Common Infectious Organisms Causing Chronic Diarrhea in Renal Transplant Patients. Experimental and Clinical Transplantation, 17(Suppl 1), 212-215. https://doi.org/10.6002/ect.mesot2018.p69 Reference #3: 3. Kristensen, A. A., Horneland, R., Birn, H., & Svensson, M. (2016). Giardia lambliainfection after pancreas-kidney transplantation. BMJ Case Reports. https://doi.org/10.1136/bcr-2015-211515 DISCLOSURES: No relevant relationships by Luis Angel, source=Web Response No relevant relationships by Melissa Lesko, source=Web Response No relevant relationships by Sheeja Schuster, source=Web Response