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Old 09-23-2012
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Arrow Gyrus Daily Questions; Internal Medicine #25

A 50-year-old female receives an uncomplicated double lung transplant for a history of primary pulmonary hypertension. She was cytomegalovirus (CMV)-seropositive and received CMV prophylaxis immediately after the transplant. On postoperative day 7 she developed fever and a new infiltrate infiltrate in the right lung. Which of the following organisms is most likely to be the causative agent of these findings?

A. Cytomegalovirus
B. Listeria monocytogenes
C. Nocardia asteroides
D. Pneumocystis carinii
E. Pseudomonas aeruginosa
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Old 09-23-2012
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transplant -> immunodeficiency -> D. Pneumocystis carinii?
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Old 09-23-2012
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Yah.....Answer D due to immunosupression
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Old 09-23-2012
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PCP, only clue is immunodepression

CMV cannot be because she was given prophylaxis

Other options are vague and cannot be chosen from the info provided...
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D. Pneumocystis jirovecii

Quote:
PCP can also develop in patients who are taking immunosuppressive medications. It can occur in patients who have undergone solid organ transplantation or bone marrow transplantation and after surgery.[10] Infections with Pneumocystis pneumonia are also common in infants with hyper IgM syndrome, an X-linked or autosomal recessive trait.
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