Background:The “Remission Hypothesis” suggests that in patients with both HIV and UC an immunosuppressed state allows for the remission of UC and decreased number of flares. While the exact mechanism is unknown, this theory considers the relationship between CD4 count and flare progression. However, currently literature does not take into account the role that viral load might play in modulating flare activity.Methods:This is a case series including three patients with concurrent HIV and IBD at two large urban academic centers. A retrospective chart review was done and clinical information such as CD4+ count, viral load and flare symptoms were collected for each patient.Results:Three patients with a total of eleven UC flares were evaluated between the years of 2007 and 2018. Of the eleven flares, nine flares occurred while the viral load was undetectable, one flare occurred while the viral load was unknown, and one flare while the viral load was detectable.Conclusions:Nine out of eleven UC flares occurred while the patients’ viral loads were undetectable, which can support a “Remission Hypothesis” which is inclusive of viral load instead of CD4+ count. However, it is important to note that the disease progression of Patient 3 does not completely support this version of the hypothesis. While we cannot comment on whether the “Remission Hypothesis” is true or not, we do believe a more inclusive theory including viral load should be considered.

INTRODUCTION: VACTERL association is not known to be a predisposing factor to malignancy. We present a rare case of carcinoid tumor presenting in a young, man with VACTERL. CASE PRESENTATION: An 18-year-old black male with a history of right-sided hydronephrosis with right nephrectomy at 7months old, clubbed feet, scoliosis and patent VSD presented to SUNY Downstate Medical Center with intermittent hemoptysis for four months. Physical exam demonstrated scoliosis and a grade 3/6 pansystolic murmur. Labs were unremarkable. CT of the chest revealed a 2.3cm right peribronchial mass with an endobronchial component eroding into the bifurcation of the bronchus intermedius. Subsequent bronchoscopy and biopsy of the mass revealed epithelial cells in a chondromyxoid stroma suggestive of a pleomorphic adenoma. Video-Assisted Thorascopic surgery (VATS) and bilobectomy of the right middle and lower lung lobes provided surgical histology, which confirmed the diagnosis of Typical Carcinoid tumor. Somatostatin Receptor Scintigraphy (SRS) showed no evidence of residual tumor or metastases.

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