A 32-year-old woman arrives to the emergency room with a worsening cough, shortness of breath, and low-grade fevers that had persisted for four weeks. She has also lost 4.5 kg (10 lb) unintentionally during the last three months. The temperature is 37.1 degrees Celsius (98.8 degrees Fahrenheit), the blood pressure is 120/70 mm Hg, the pulse is 102/min, and the respirations are 22 per minute. On ambient air, pulse oximetry showed an 86 percent saturation. Auscultation of the lungs revealed bilateral crackles. There are no murmurs in the heart, and the jugular venous pressure is normal. An x-ray of the chest indicates widespread interstitial infiltrates. The patient has a bronchoscopy; the picture shows methenamine silver staining of the bronchoalveolar lavage material. Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

Question

A 32-year-old woman arrives to the emergency room with a worsening cough, shortness of breath, and low-grade fevers that had persisted for four weeks. She has also lost 4.5 kg (10 lb) unintentionally during the last three months. The temperature is 37.1 degrees Celsius (98.8 degrees Fahrenheit), the blood pressure is 120/70 mm Hg, the pulse is 102/min, and the respirations are 22 per minute. On ambient air, pulse oximetry showed an 86 percent saturation. Auscultation of the lungs revealed bilateral crackles. There are no murmurs in the heart, and the jugular venous pressure is normal. An x-ray of the chest indicates widespread interstitial infiltrates. The patient has a bronchoscopy; the picture shows methenamine silver staining of the bronchoalveolar lavage material.  Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Pneumocystis pneumonia is common in patients with advanced HIV and usually presents with slowly worsening cough and dyspnea, hypoxia, and bilateral interstitial infiltrates.  Diagnosis requires visualizing the organism in respiratory secretions using special stains (eg, methenamine silver stain).  First-line treatment is trimethoprim-sulfamethoxazole.

A 32-Year-Old Woman Arrives to the Emergency Room with a Worsening