The role of norethindrone acetate (NA) in the management of adenomyosis was evaluated with a retrospective chart review of 28 premenopausal women between 27–49 years of age presenting with moderate to severe pelvic pain and bleeding. Bleeding and dysmenorrhea scores were analyzed using paired T-tests. There was significant improvement of both dysmenorrhea and bleeding after treatment. Age showed no correlation with dysmenorrhea or bleeding. Low dose NA could be considered an effective, well-tolerated and inexpensive medical alternative to surgery for treating symptomatic adenomyosis. Large multicentric studies may help validate our findings.

Acremonium is a saprophytic fungus mostly causing superficial skin, nail, or ocular infections after traumatic inoculation. However, it is being recently recognized as one of the opportunistic infections in immunocompromised patients including neutropenia, malignancies, chronic granulomatous disease (CGD) and transplant recipients. To our knowledge there have been no reported cases of Acremonium infection, related to HIV or AIDS. We present a case of Acremonium pneumonia in a patient with no past medical history who was found to have AIDS.

Background The use of combination antiretroviral therapy (ARVT) has made it possible to halt HIV replication, achieve CD4+ recovery and immune reconstitution. Some patients with long-term viral suppression never adequately recover their CD4+ count and manifest increased mortality. Age, CD4+ nadir, Hepatitis C infection have been associated with incomplete immune recovery. By matching for age, gender, and CD4 nadir, we aim to elucidate the role of clinical factors in virally suppressed patients with suboptimal CD4 recovery.Methods Retrospective record review of patients with CD4 <200 (Cases) and CD4 >500 (Controls) with over 2 years of viral supression (viral load <200) on ARVT for the same duration, was conducted. One case was matched to 2 controls by age, gender and CD4 nadir. Associations between variables were assessed using univariable exact conditional logistic regressions.ResultsOf the 1265 charts reviewed, 13 cases were identified. A unit higher BMI was significantly associated with a 13% lower odds of having low CD4 (P = 0.04). Higher hemoglobin A1c (A1c) was associated with 82% lower odds of having low CD4 (P = 0.02). Other non-significant comparisons include ethnicity; 33% cases were Hispanic vs. 16% controls. Gastrointestinal (GI) symptoms were more common in the cases (83% vs. 50%), as was lymphadenopathy (LAD) (36.4% vs. 25%). Mean years since diagnosis was longer in cases (19.2 vs. 16.7) despite the duration of ARVT being longer in controls. Mean number of comorbidities was higher in cases (3.17 vs. 2.75). Controls had more statin use (45.8% vs. 25%).Conclusion Incomplete CD4 recovery was significantly associated with lower BMI, suggesting that despite viral suppression, these patients are vulnerable to metabolic issues that affect uncontrolled HIV patients. We hypothesize that rapid control of HIV in this suburban population was associated with weight gain and note that the BMI in controls was in the obesity range. Statin use may play a protective role in the controls, perhaps due to its anti-inflammatory properties. Trends in GI symptoms, LAD, number of comorbidities, albeit not statistically significant, seem to be important. Due to small sample size, this study was underpowered to fully assess the effect of these factors. Thus this study should be considered exploratory.Disclosures All authors: No reported disclosures.

Aerococcus urinae, a previously misidentified pathogen, has become increasingly recognized to cause severe and even fatal infections. Aerococcus-related perineal abscess infections have not previously been reported in the literature. Most reported cases of infections caused by Aerococcus are urinary tract infections, bacteremia, and even rare cases of endocarditis. We report an unusual case of a perineal abscess caused by Aerococcus urinae.