A 35-year-old construction worker in Arizona presents with fever (38.9°C), productive cough, and pleuritic chest pain. Examination reveals erythema nodosum on bilateral shins. Vital signs show BP 128/82, HR 98, RR 20, SpO2 98% on room air. Chest radiograph demonstrates patchy alveolar infiltrates with hilar lymphadenopathy. Laboratory studies reveal elevated ACE level at 68 U/L. He denies hemoptysis. Which organism most likely explains this clinical presentation?
- A)Coccidioides immitisGABARITO
- B)Histoplasma capsulatum
- C)Blastomyces dermatitidis
- D)Streptococcus pneumoniae
- E)Legionella pneumophila
Explicação
Coccidioides immitis is correct. Desert Southwest exposure combined with pneumonia and erythema nodosum is classic for coccidioidomycosis. Tissue forms show large spherules filled with endospores rather than budding yeasts. Ver explicação completa e trilha adaptativa →