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

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B The clinical history and chest radiograph are most consistent with cytomegalovirus pneumonitis and the patient should immediately receive intravenous ganciclovir (Cytovene).

This answer is incorrect. Cytomegalovirus is now known to be an uncommon cause of pneumonia in patients with AIDS. In addition, this patient’s CD4 cell count is too high for development of cytomegalovirus disease; most cases occur in patients with CD4 cell counts less than 50 cells/mm3.

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