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By Kapit W., Elson M.

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The general medical examination is unremarkable. On neurologic examination, nuchal rigidity is noted, but no additional focal findings are present. 7 mmol/L), and protein level of 90 mg/dL (900 mg/L). CSF IgG complement fixation is positive for Coccidioides immitis. MRI of the brain shows generalized leptomeningeal enhancement. Which of the following is the most appropriate treatment? A Caspofungin B Fluconazole C Intrathecal amphotericin B D Itraconazole Answer & Critique Correct Answer: B Educational Objective: Treat a patient with Coccidioides immitis meningitis.

He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. Medical history is otherwise unremarkable, and he takes no medications. On physical examination, vital signs are normal. BMI is 22. Track marks secondary to injection drug use are present bilaterally on the antecubital fossa, without tenderness, warmth, erythema, or fluctuance. Cardiopulmonary examination and all other examination findings are normal.

No rash is noted, and the neurologic examination is normal. 6 × 109/L) Alkaline phosphatase 349 U/L Serum aminotransferases, bilirubin, and kidney function are normal. Chest radiograph is normal. Abdominal CT shows retroperitoneal lymphadenopathy; diffuse hepatic and splenic enlargement without focal lesions; and normal stomach, small and large bowel, and kidneys. Which of the following is the most likely diagnosis? A Cytomegalovirus infection B Disseminated candidal infection C Disseminated Mycobacterium avium complex infection D Medication toxicity Answer & Critique Correct Answer: C This patient has immune reconstitution inflammatory syndrome (IRIS) caused by disseminated Mycobacterium avium complex (DMAC) infection.

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Anatomy Coloring Book by Kapit W., Elson M.

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