A 45-year-old renal transplant patient has a persistent fever on day 4 in the ICU. He was diagnosed with pneumonia, confirmed by a chest X-ray, and his laboratory tests identified neutropenia. He received cyclosporine to prevent graft rejection and has not been dependent on hemodialysis since his transplant. His absolute neutrophil count (ANC) was 90 cells/mm 3 with a WBC of 1000 cells/mm 3 . Reverse isolation and triple antibiotic therapy with IV vancomycin, levofloxacin, and ceftazidime were started empirically.
A central line was placed for fluid support. Blood, urine, and sputum specimens were taken for gram stain, routine culture, acid-fast stain and culture, fungus smears and cultures, and cytology. The patient had a history of being PPD-positive 20 years ago. Despite the empiric antimicrobial therapy, he continued to appear ill and had a temperature of 101.2 o F. What is the…
