A 45-year-old woman comes to the emergency department due to 3 days of fever

A 45-year-old woman comes to the emergency department due to 3 days of fever, malaise, progressive dyspnea on exertion, dry cough,

abdominal pain, and watery diarrhea. Her loose stools this morning were accompanied by bright red blood. The patient underwent allogeneic

renal transplantation 6 months ago and is currently taking tacrolimus, mycophenolate, and prednisone. Two months ago, she developed severe

leukopenia, which resolved after discontinuing trimethoprim-sulfamethoxazole and valganciclovir. She does not use tobacco, alcohol, or illicit

drugs. Temperature is 38.9 C (102 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min. Physical examination

shows bilateral lung crackles and diffuse abdominal tenderness. Gross blood is seen on rectal examination. Laboratory results are as follows:

Complete blood count

Hematocrit 30%

Platelets 118,000/mm3

Leukocytes 3,800/mm3

Serum chemistry

Blood urea nitrogen 24 mg/dL

Creatinine 1.2 mg/dL

Liver function studies

Total bilirubin 1.3 mg/dL

Alkaline phosphatase 124 U/L

Aspartate aminotransferase 137 U/L

Alanine aminotransferase 114 U/L

Urinalysis is normal. Chest x-ray reveals bilateral interstitial infiltrates. Which of the following is the most likely cause of this patient’s current


  • QA Aspergillus fumigatus
  • 0 B. Candida albicans
  • 0 C . Cryptosporidium
  • 0 D. Cytomegalovirus
  • 0 E. Influenza
  • 0 F Legionel/a pneumophila
  • 0 G. Mycoplasma pneumoniae
  • 0 H. Pneumocyst is jirovecii

0 voters


Solid organ transplantation increased risk of opportunistic infection especially pneumocystic & CMV