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nbme20/Block 3/Question#35 (43.6 difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infection🔍,📺
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 +34 
submitted by amorah(94),
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Frvee -;tg& lure uto eflt nlucarverti ulriaef MPMX TS- lyipxhpsroa t;g-& erul tuo smcyeiosnutP idycionevjrei K aaptnlrtsn utb no BBRCCW/ in nerui -&g;t ruel tou antatrslpn rceitejon

vginaLe VCM dan latiaycp mtcoeuayimbrc sa eht eigmnanri otw oonst.pi CVM si moer eiykll ni a tnnsarlapt ietpn.at




 +4 
submitted by hayayah(1081),
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VCM si saiedctaso whti ncntgiefi narog stlnrantap .ptenisat VMC si smtettarndi iva aueslx cat,octn ragno narns,talpt ro ytavlicerl vai l.eptnaca iieatRoantcv of CVM rsccuo in teh ummdineoesupps.rs

rOang latnrntspa aesntpit rae ta na iersecadn riks fo VCM unm.ionaep




 +1 
submitted by lifeisruff(1),

he was never given ganciclovir - i used that as a clue over transplant rejection




 +0 
submitted by mrglass(39),
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Why wodlu shit tno be aeutc nlantsartp eoijrtecn ilendag to SAD?R Teh riieneatnc is ed,tevale adn I ese nay narsoe hwy it wduol eb taveeled eodbny ionjecert

sammyj98  I selected the same. I think part of the question wanted us to recognize that the pt was not receiving CMV prophylaxis (hinted that they are getting TMP-SMX but no Gancyclovir) so they're at really high risk for CMV specifically. UpToDate: •Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations. (See 'Cytomegalovirus' above.) +  
utap2001  I was also confused by acute rejection. CMV cannot be completely D/D with rejection. But the drug used is hint. The stem says they used cyclosporine, prednisone. That should rule out rejection. +  

via @sammyj98 via UpToDate:

Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations.

+2/- drdoom(896),