A 53-Year-Old Woman with Long-Standing Rheumatoid Arthritis Comes to the Emergency

question 526

Multiple Choice

A 53-year-old woman with long-standing rheumatoid arthritis comes to the emergency department due to seizures.  She has had cough, fever, and night sweats for the past 2 weeks.  She is on immunosuppressive therapy for her rheumatoid arthritis.  Her temperature is 38.9 C (102 F) , blood pressure is 120/76 mm Hg, pulse is 80/min, and respirations are 16/min.  Physical examination shows scattered rales in both lung fields.  CT scan of the chest shows multiple nodules.  CT scan of the brain shows left temporal lobe abscess.  Bronchoalveolar lavage cultures grow partially acid-fast, gram-positive, branching rods.  Which of the following is the most effective treatment for this patient?

• A)Aztreonam
• B)Clindamycin
• C)Isoniazid, rifampin, and ethambutol
• D)Penicillin G
• E)Trimethoprim-sulfamethoxazole
• F)Voriconazole

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