present for 20 years but was now having increasing odor anddrainage, and an elevated cerebriform appearance.Program Description: Hampton Veterans Affairs Medical Cen-ter, Hampton, Virginia.Setting: Inpatient spinal cord unit.Results: Results of an initial single punch biopsy favored prolifer-ative fascitis, but multiple larger incisional biopsies were recom-mended to rule out malignancy. Multiple biopsies were subse-quently sent, and all were positive for squamous cell carcinoma.Inguinal node biopsy was negative. Plastic surgery confirmed tumorinvasion into the bone. Surgical excision with sacrectomy and flapwith possible leg amputation were decided against, and the patientelected to have radiation of the sacrum for 7 weeks. Oncologyestimated a 10% cure rate with this treatment.Discussion: Marjolin ulcers may present symptoms and radio-logic findings similar to infection. A diagnosis can reliably be madeonly by biopsy at multiple sites.Conclusions: Due to the high rate of metastasis and mortality,clinicians should monitor chronic wounds for these changes andrefer for biopsy if found.

Poster 447Role of Acute Rehabilitation in a Patient WithTransverse Myelitis Secondary to Epstein-Barr Virus.Daniel Kline, MD (SUNY Downstate, Brooklyn, NY, UnitedStates); Jinghua He, MD, Getahun Kifle, MD.

Disclosures: D. Kline, none.Patients or Programs: A 48-year-old African American man.Program Description: Department of Physical Medicine andRehabilitation; Kings County Hospital, Brooklyn, NY.Setting: Inpatient acute rehabilitation unit.Results: The patient, with a history of hypertension, was admittedto the intensive care unit with a 2-week history of high fever,weakness in the lower extremities, and shortness of breath. Thepatient was subsequently admitted to the neurology service andmagnetic resonance imaging of the brain revealed abnormal signalwithin the medulla, right cerebellar peduncle, and cervicomedullaryjunction. Magnetic resonance imaging of the cervical spine demon-strated an abnormal hyperintense signal in the dorsal aspect ofC5-C7 as well as hyperintense signal from T2-L1. Laboratory testingwas positive for Epstein-Barr virus. The patient was diagnosed withtransverse myelitis secondary to Epstein-Barr virus and was startedon acyclovir. The patient was subsequently admitted to the rehabil-itation service and was at maximum assist with transfers, bedmobility, and lower extremity dressing; total assist with bathing;and unable to ambulate. The patient was 1/5 on muscle strengthtesting of the bilateral lower extremities and had bladder dysfunc-tion. The patient underwent 4 weeks of intensive physical andoccupational therapy. Upon discharge, the patient was modifiedindependent with transfers, able to ambulate 15 ft with a rollingwalker, and supervision with activities of daily living. The patientwas discharged home with a condom catheter; muscle testing re-vealed 4/5 in the bilateral lower extremities.Discussion: Transverse myelitis is caused by inflammation of thespinal cord often after viral infections. Symptoms can include pa-ralysis, urinary retention, abnormal sensation, and loss of bowelcontrol. Some patients may fully recover from transverse myelitis,whereas others may have permanent impairment.Conclusions: Transverse myelitis is a rare complication of Ep-

stein-Barr virus infection. The goal of rehabilitation is to maximizequality of life and independent living, which requires contributionsfrom the entire interdisciplinary team. In this case, with the assis-tance of the team, the patient was able to be discharged home withthe ability to take care of himself and ambulate with a rolling walker.

Poster 448Acute Biliary Pancreatitis Presenting as an Ileus ina Patient With Tetraplegia: A Case Report.Mark England (Medical College of Wisconsin, Milwau-kee, WI, United States); Paula Benes, MD.

Disclosures: M. England, none.Patients or Programs: A 72-year-man with long-standing, in-complete tetraplegia experiencing bloating and abdominal distension.Program Description: The patient reported abdominal disten-sion and feeling bloated after an unsuccessful morning bowel routine.An abdominal radiograph showed gaseous distension and a mild ileus,and the patient planned to repeat a bowel routine in the evening. Hourslater, he developed nausea and vomiting. Further workup showed hissymptoms to be due to acute biliary pancreatitis.Setting: A Veterans Affairs spinal cord injury unit.Results: The patient was treated with supportive care, includingholding oral intake, an nasogastric tube for decompression, andintravenous fluids. He developed elevated pancreatic enzymes, livertransaminases, biliary markers, and a coagulopathy. Imaging of theabdomen revealed no clear etiology. His Ranson score was 3, whichindicated moderate-to-severe pancreatitis and an 11%-15% pre-dicted mortality. With supportive care only, the patient had com-plete recovery, including resolution of all symptoms, and laboratoryvalues returned to normal.Discussion: Acute pancreatitis is an urgent, life-threatening con-dition often presenting with severe abdominal or back pain, nausea,and vomiting. In most cases, the etiology is attributed to gallstonesor alcohol abuse. In patients with altered sensation, typical symp-toms may not present, and the practitioner must have a high level ofsuspicion for the correct, early diagnosis. It has been established thatpatients with spinal cord injury are at an increased risk for develop-ing pancreatitis in the first few weeks after their injury. Althoughpeople with long-term spinal cord injury are at an increased risk forcholelithiasis, they do not appear to be at increased risk for acutepancreatitis relative to people without spinal cord injury. Earlyrecognition of acute pancreatitis in people with spinal cord injury iscritical in initiating treatment and reducing morbidity, hospitallength of stay, mortality, and health care costs.Conclusions: In the population with spinal cord injury, severeintra-abdominal pathology, such as pancreatitis, can present with-out normal expected findings. A high index of suspicion by thepractitioner is necessary to differentiate between a mild process andan urgent, possibly life-threatening condition.

Poster 449Development of Herpes Zoster in a DermatomeUnrelated to Surgical Incision After HematomaEvacuation in a Patient With SpontaneousHemorrhagic Spinal Cord Injury: A Case Report.Samuel A. Yoakum, DO (Loyola University MedicalCenter, Maywood, IL, United States); Ning Jiang, MD.

Disclosures: S. A. Yoakum, none.

S330 PRESENTATIONS