A 34-Year-Old Immigrant from Brazil Comes to the Physician with 2

question 75

Multiple Choice

A 34-year-old immigrant from Brazil comes to the physician with 2 months of palpitations accompanied by lightheadedness.  He also complains of mild shortness of breath.  The patient suffers from moderate, persistent asthma and takes daily inhaled glucocorticoid and salmeterol.  He received "most of the childhood immunizations."  He has no family history of heart disease or sudden cardiac death.
The patient's blood pressure is 122/70 mm Hg and pulse is 82/min.  Estimated jugular venous pressure is normal.  The apical impulse is displaced to the left.  A soft 2/6 holosystolic murmur is heard at the apex.  Lungs are clear on auscultation.  There is no organomegaly, skin rash, or peripheral edema.
Electrocardiogram shows normal sinus rhythm with right bundle branch block.  Echocardiogram shows a left ventricular apical aneurysm and left ventricular ejection fraction of 35%.  Cardiac catheterization shows normal coronary arteries.
Which of the following is most likely responsible for this patient's condition?

• A)Blastomyces dermatitidis
• B)Borrelia burgdorferi
• C)Dengue virus
• D)Leishmania donovani
• E)Trypanosoma cruzi

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