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Case 2: A 40-Year-Old with Fever and Respiratory Symptoms

You answered:

A The clinical picture and chest radiograph are most consistent with a diagnosis of Mycoplasma pneumonia, and the patient should receive amoxicillin-clavulanate (Augmentin).

This answer is incorrect. Although it is certainly possible that the patient could have Mycoplasma pneumonia, the diagnosis of Pneumocystis pneumonia is more likely, particularly given the severe hypoxemia and the patient’s recent CD4 cell count. In addition, amoxicillin-clavulanate is not considered appropriate therapy for Mycoplasma pneumonia.

Choose another answer:

B The clinical history and chest radiograph are most consistent with cytomegalovirus pneumonitis and the patient should immediately receive intravenous ganciclovir (Cytovene).
C The clinical history and chest radiograph are most consistent with a diagnosis of Pneumocystis pneumonia. The patient should be started on high-dose trimethoprim-sulfamethoxazole plus corticosteroids and should undergo a work-up to establish the diagnosis.
D The clinical history and chest radiograph are most consistent with a diagnosis of diffuse pulmonary Mycobacterium avium complex infection and the patient should receive clarithromycin (Biaxin) plus ethambutol (Myambutol).

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