Fever -> rule out left ventricular failure TMP-SMX prophylaxis -> rule out Pneumocystis jiroveci Kidney transplant but no WBC/RBC in urine -> rule out transplant rejection
Leaving CMV and atypical mycobacterium as the remaining two options. CMV is more likely in a transplant patient.
CMV is associated with infecting organ transplant patients. CMV is transmitted via sexual contact, organ transplant, or vertically via placenta. Reactivation of CMV occurs in the immunosuppressed.
Organ transplant patients are at an increased risk of CMV pneumonia.
he was never given ganciclovir - i used that as a clue over transplant rejection
Why would this not be acute transplant rejection leading to ARDS? The creatinine is elevated, and I see any reason why it would be elevated beyond rejection
via @sammyj98 via UpToDate:
Universal prophylaxis with
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.