Match each clinical presentation of an immunocompromised patient with the most appropriate primary pharmacotherapy for their underlying condition.
- A patient with profound chemotherapy-induced neutropenia who develops fever, pleuritic chest pain, and a pulmonary nodule with a surrounding ground-glass halo.Intravenous voriconazole
- A patient with advanced HIV presenting with subacute headache and an elevated opening pressure on lumbar puncture; CSF shows encapsulated yeast.Liposomal amphotericin B and flucytosine
- A patient with advanced HIV presenting with progressive focal neurologic deficits; brain MRI reveals asymmetric, non-enhancing white matter lesions lacking mass effect.Initiation of combination antiretroviral therapy (cART)
- A solid-organ transplant recipient presenting two months post-operation with fever, cytopenias, and a positive serum PCR for a beta-herpesvirus.Intravenous ganciclovir or oral valganciclovir
Answer
Invasive aspergillosis (halo sign) pairs with voriconazole. Cryptococcal meningitis (encapsulated yeast, high opening pressure) pairs with liposomal amphotericin B and flucytosine. Progressive multifocal leukoencephalopathy (non-enhancing white matter lesions) pairs with combination antiretroviral therapy. Cytomegalovirus (post-transplant cytopenias, beta-herpesvirus) pairs with ganciclovir or valganciclovir.
Each specific opportunistic infection requires a targeted primary approach: voriconazole for invasive aspergillosis, amphotericin B and flucytosine for induction in cryptococcal meningitis, cART for immune reconstitution in PML, and ganciclovir for CMV.
Step-by-Step Solution
Key Concept
Targeted management of opportunistic infections in immunocompromised patients depends heavily on correlating specific radiographic and laboratory clues with the causative organism.
Estimated Time:1m 30s