A 56-year-old man comes to the emergency department because of progressively worsening shortness of breath and fever for 2 days. He also has a nonproductive cough. He does not have chest pain or headache. He has chronic myeloid leukemia and had a bone marrow transplant 3 months ago. His current medications include busulfan, mycophenolate mofetil, tacrolimus, and methylprednisolone. His temperature is 38.1°C (100.6°F), pulse is 103/min, respirations are 26/min, and blood pressure is 130/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Pulmonary examination shows diffuse crackles. The spleen tip is palpated 4 cm below the left costal margin. Laboratory studies show: Hemoglobin 10.3 g/dL Leukocyte count 4,400/mm3 Platelet count 160,000/mm3 Serum Glucose 78 mg/dL Creatinine 2.1 mg/dL D-dimer 96 ng/mL (N < 250) pp65 antigen positive Galactomannan antigen negative Urinalysis is normal. An x-ray of the chest shows diffuse bilateral interstitial infiltrates. An ECG shows sinus tachycardia. Which of the following is the most appropriate pharmacotherapy?
ALevofloxacin
BGanciclovir
CValganciclovir
DAzithromycin
EAcyclovir
A 37-year-old man who had undergone liver transplantation 7 years ago, presents to the physician because of yellowish discoloration of the skin, sclera, and urine. He is on regular immunosuppressive therapy and is well-adherent to the treatment. He has no comorbidities and is not taking any other medication. He provides a history of similar episodes of yellowish skin discoloration 6–7 times since he underwent liver transplantation. Physical examination shows clinical jaundice. Laboratory studies show: While blood cell (WBC) count 4,400/mm3 Hemoglobin 11.1 g/dL Serum creatinine 0.9 mg/dL Serum bilirubin (total) 44 mg/dL Aspartate transaminase (AST) 1,111 U/L Alanine transaminase (ALT) 671 U/L Serum gamma-glutamyl transpeptidase 777 U/L Alkaline phosphatase 888 U/L Prothrombin time 17 seconds A Doppler ultrasound shows significantly reduced blood flow into the transplanted liver. A biopsy of the transplanted liver is likely to show which of the following histological features?
ABallooning degeneration of hepatocytes
BNormal architecture of bile ducts and hepatocytes
CIrregularly shaped nodules of regenerating hepatocytes with peripheral halo
DBroad fibrous septations with formation of micronodules
EInterstitial cellular infiltration with parenchymal fibrosis, obliterative arteritis
A 43-year-old woman comes to the office with a 5-day history of a rash. She's had a rash across her neck, shoulders, and the palms of her hands for the past five days. She's also had large-volume watery diarrhea for the same period of time. Past medical history is notable for acute myeloid leukemia, for which she received a stem cell transplant from a donor about two months prior. Physical exam reveals a faint red maculopapular rash across her neck, shoulders, and hands, as well as an enlarged liver and spleen. Labs are notable for a total bilirubin of 10. Which of the following is the mechanism of this patient's pathology?
ADrug hypersensitivity reaction
BHost CD8+ T cells against graft antigens
CGraft T cells against host antigens
DPre-existing host antibodies against graft antigens
EHost antibodies that have developed against graft antigens
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