Justin joins the TWiP team to solve the case of the Gentleman with B cell Lymphoma, and consider the finding of Dracunculus species in river otters from Arkansas. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Justin Aaron Become a patron of TWiP. Links for this episode: Dracunculus in river otters (J Parasitol) Image credit Letters read on TWiP 155 Case Study for TWiP 155 Another challenging one. 60 yo man with poorly defined immunodeficiency: low Ig, low T cells, on chronic Ig therapy. Admitted with 1 yr chronic diarrhea. Had upper endoscopy, inflammation of duodenum, crypt hyperplasia, diffuse ulceration. Lower colonoscopy: granular appearance to cecal mucosa. Loss of haustral folds. Biopsies done and sent for culture. PMH: poorly understood interstitial lung disease. Unable to work, no toxic habits. Born Ecuador, moved to US in early 40s, living in Staten Island. No fever, bp low, hr >100, resp high teens. Remarkable: looks frail but not terribly ill. Labs: normal WBC, shifted to left with increase in neutrophils and eosinophils. Albumin low; respiratory pathogen positive for rhinovirus. Serum CMV: >4000 (virus measurement). Started on ivermectin, WBC rises, broad spectrum Ab. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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