A 50-Year-Old Man Comes to the Emergency Department Due to 2

question 290

Multiple Choice

A 50-year-old man comes to the emergency department due to 2 days of malaise, decreased appetite, abdominal discomfort, and bloody stools.  The patient had end-stage renal disease and underwent kidney transplantation 4 months ago.  He had no major postoperative issues and currently takes mycophenolate, tacrolimus, and prednisone.  The patient has a 15 pack-year smoking history but quit several years ago.  Temperature is 37 C (98.6 F) , blood pressure is 110/70 mm Hg, pulse is 104/min, and respirations are 22/min.  Physical examination shows mild abdominal tenderness in the left lower quadrant.  Rectal examination is normal.  Stool is guaiac positive.  Laboratory results are as follows: Atypical lymphocytes are seen on peripheral blood smear.  A colonoscopy reveals multiple ulcerations throughout the colon.  Which of the following is the most likely diagnosis for this patient?

• A)Cytomegalovirus infection
• B)Epstein-Barr virus infection
• C)Graft-versus-host disease
• D)Herpes simplex virus-1 infection
• E)Ischemic colitis

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