A 66-year-old woman presents with three months of shortness of breath, left-sided ear pain, and hemoptysis. Her family history is significant for rheumatoid arthritis and multiple sclerosis. She has an allergy to sulfa. On examination, there is evidence of chronic sinusitis, palpable purpura in the lower extremities, and active arthritis in multiple joints. Laboratory findings are notable for an increased ESR, elevated creatinine, and a positive c-ANCA. A chest CT demonstrates the findings above. A referral is made for plasma exchange and immunosuppressive therapy. Which of the following is most appropriate for pneumocystis pneumonia prophylaxis? A) Trimethoprim-sulfamethoxazole B) Doxycycline C) Atovaquone D) Pentamidine

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Granulomatosis with polyangiitis (Wegener’s) is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis. In addition, variable degrees of disseminated vasculitis involving both small arteries and veins may occur. Aerosolized Pentamidine once a month wd be a preferable option

D) Pentamidine Preferably aerosol. Or intermittent parenteral pentamidine.

D

Thanx dr Ashok Leel
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D) Pantamidine

Thanks Dr Pushkar Bhomia
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A will be right, but patient is allergic to sulpha and Trimithoprim sulphamethoxazole cannot be used . So, D is right

D) is rt

Pantamidine(D)

A trimethoprim sulphamethaxazole

SUGGESTIVE OF D .. PENTAMIDINE

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