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

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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).

This answer is incorrect. Although Mycobacterium avium complex can sometimes cause pulmonary disease, it is not common, and the presentation is not one of diffuse infiltrates with marked hypoxemia. Disseminated disease due to Mycobacterium avium complex typically occurs in patients with CD4 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).
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.

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