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

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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.

This answer is correct. The clinical history and chest radiograph are most consistent with Pneumocystis pneumonia, especially considering that the patient had a CD4 count less than 200 cells/mm3 and was not taking Pneumocystis pneumonia prophylaxis. The recommended therapy for Pneumocystis pneumonia is trimethoprim-sulfamethoxazole, and corticosteroids are indicated if the pO2 is less than 70 mm Hg or the alveolar-arterial oxygen gradient is greater than 35. Empiric therapy for Pneumocystis pneumonia should be initiated at the time the diagnosis is suspected, and the patient should then undergo tests to confirm the diagnosis.

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