A 65-Year-Old Man Comes to the Emergency Department with a Sore

question 195

Multiple Choice

A 65-year-old man comes to the emergency department with a sore on his right hand.  The lesion began as a small, painless papule 3 days ago and rapidly enlarged and ulcerated.  The patient has had no injury or insect bite, has no prior medical conditions, and takes no medications.  He is in the wool business and recently returned from a tour of wool-processing plants in several Asian countries.  Physical examination shows a necrotic ulcer with a black eschar on the dorsum of the right hand.  There is extensive edema of surrounding tissues.  The toxin causing edema around this patient's ulcer has a mechanism of action most similar to a different toxin produced by which of the following bacteria?

• A)Bordetella pertussis
• B)Clostridium botulinum
• C)Clostridium difficile
• D)Shigella dysenteriae
• E)Streptococcus pyogenes

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