A 35-year-old man comes to the physician with a 2-month history of fever, night sweats, and a cough productive of white sputum. He lives in New York and is currently homeless. He uses intravenous heroin several times a week. Three months ago he was admitted to the hospital for aspiration pneumonia. His dad passed away at the age of 54 because of "a bad heart condition." His temperature is 38°C (100.4°F) and respirations are 22/min. Physical examination shows coarse crackles in the left upper posterior lung field. An x-ray of the chest shows a cavitary lesion with calcification in the left upper lobe. Which of the following is the most likely source of his pulmonary findings?
- A)Aspiration of oral flora
- B)Exposure to contaminated hot water tanks
- C)Reactivation of a latent infectionGABARITO
- D)Embolization of a bacterial vegetation
- E)Close contact with pigeon droppings
Explicação
This patient's findings (fever, night sweats, productive cough, and a pulmonary cavitary lesion on chest x-ray) combined with risk factors for immunocompromise (homelessness, IV drug use) are consistent with reactivation tuberculosis. The initial M. tuberculos... Ver explicação completa e trilha adaptativa →