Active substances: Ciprofloxacin
His physical examination revealed crackles at both lung bases.
A radiograph of the chest demonstrated opacity at the right lung base. Findings of a CT scan of the chest revealed diffuse ground glass opacities and septal thickening. Over a period of 2 days, the patient developed mild dyspnea and dry cough.
A sample of bronchoscopic alveolar lavage BAL fluid was obtained, and indirect immunofluorescence staining of the sample was positive for P.
In this patient, atovaquone was used instead of TMP-SMX because of persistent thrombocytopenia after stem cell transplantation.
Patient 2 was a 67-year-old man with a history of ischemic cardiomyopathy underwent orthotopic heart transplantation.
He was admitted to MGH with cough and shortness of breath 3 years later.
His symptoms evolved during a 3-month period and included progressive dry cough, dyspnea, occasional chills, lethargy, decreased appetite, and weight loss; he denied having a fever. The patient had a history of multiple episodes of severe acute graft rejection that were treated with bolus corticosteroid therapy.
One such episode, which occurred 1 year before this admission, was accompanied by cytomegalovirus CMV gastritis, duodenitis, and colitis.
His medications included tacrolimus 1 mg b.
The findings of his physical examination were remarkable for a gallop rhythm and bilateral crackles at the lung bases.
He received piperacillin-tazobactam, valganciclovir at a reduced dose of 450 mg q. The results of a CMV antigenemia assay were negative.