TRANSPLANT PATIENT. M. Schaeffer 1 , E. Warm 1 ; 1 University of Cincinnati, Cincinnati, OH (Tracking ID #74228) LEARNING OBJECTIVES: 1) To understand that patients undergoing solid organ transplantation require immunosupressive medications and should undergo thorough evaluation for infectious diseases with consideration of subclinical parasitic infections. 2) To understand that patients taking glucocorticoids have compromised cell-mediated immunity and are susceptible to life-threatening infections by organisms that typically cause mild or no disease in healthy individuals. CASE INFORMATION: Solid organ transplant patients require immunosuppression and are susceptible to many life-threatening infections. We report a case of fatal fulminate infection with Strongyloides stercoralis 3 months following orthotopic heart transplantation. A 54-yearold male underwent orthotopic heart transplantation for ischemic cardiomyopathy. Over the next 6 weeks he required increasing doses of prednisone, tacrolimus and mycophenolate mofetil for graft rejection. 8 weeks after transplant he suffered a perforated colonic diverticulum, and underwent emergent surgery. On postoperative day 14 he developed hypotension, respiratory failure and decreased mental status. S. stercoralis was identified in stool and bronchoalveolar aspirate, and Gram negative bacteremia was found. LP revealed motile S. stercoralis larvae in CSF and Gram negative meningitis. Brain MRI revealed multiple areas of signal change consistent with extensive new infarcts. After 10 days of supportive care and antibiotics, treatment was withdrawn at the family's request and the patient died. IMPLICATIONS/DISCUSSION: Strongyloides Hyperinfection Syndrome (SHS) occurs when massive infestation by S. stercoralis occurs in the lungs, GI tract and rarely in the central nervous system (CNS). Strongyloides stercoralis is a helminthic parasite endemic to the southeastern region of the United States. S. stercoralis has a complex life cycle in the human involving the skin, circulatory system, lungs, and gastrointestinal tract. Compromised host defenses leads to susceptibility to SHS. Along with this massive invasion of S. stercoralis, secondary Gram-negative bacteremia and sepsis are common. CNS invasion is not common but has devastating consequences, as seen in our patient. Perhaps the most damaging aspect of CNS invasion by S. stercoralis occurs when bacteria cross the blood-brain barrier attached to the parasite or within the gut of the worm leading to secondary bacterial meningitis. Although pre-transplant patients infection screening occurs, thorough assessment for parasites is often lacking. In patients in endemic areas and with risk factors for subclinical parasitic infestation, consideration should be given to further evaluation prior to surgery and initiation of immunosupressive medications. Overall mortality of SHS is greater than 80%.