A 44-year-old man with a prior renal transplant presents to the clinic for evaluation of symptoms consisting of a cough and shortness of breath on exertion. There is no sputum production and he has no prior respiratory or cardiac illnesses. On physical examination, he appears dyspneic, respirations 24/min, pulse 110/min, and oxygen saturation 88%. His lungs are clear on auscultation and heart sounds are normal. CXR shows bilateral diffuse perihilar infiltrates. Bronchoscopy and bronchial brushings show clusters of cysts that stain with methenamine silver. Which of the following is the most appropriate next step in management?
High-Yield Explanation
The treatment of choice is trimethoprim-sulfamethoxazole. The patient has Pneumocystis jiroveci pneumonia, since he is immunocompromised from antirejection medications for his renal transplant. Alternate therapies include IV pentamidine or IV clindamycin and primaquine.