🧵 1/5 Hello #IDtwitter. Here is our weekly #IDtrivia 📖 #IDboardreview #TxID #MedEd
37 y/o F PMHx of lupus nephritis complicated by ESRD s/p living-donor kidney transplant 5 months ago, who presents with 3 days Hx of dysuria, hematuria, pelvic pain and subjective fever
37 y/o F PMHx of lupus nephritis complicated by ESRD s/p living-donor kidney transplant 5 months ago, who presents with 3 days Hx of dysuria, hematuria, pelvic pain and subjective fever
2/5 She denies recent lupus flares. Patient is taking tacrolimus, mycophenolate, prednisone and TMP-SMX. Vaccinated against COVID-19x3. No sexually active for the past year. PreTransplant HIV,CMV,HepBC, adenovirus, Toxo and trypanosoma serologies (-) for both patient and donor.
3/5 On presentation BP 140/90 HR 78 RR 16 T 101 O2Sat98% RA. Hydrated mucous membranes. Clear chest to auscultation, normal heart sounds. Abdominal scar healed no signs of infection. Tenderness to palpation of hypogastrium. No CVA tendernesses.
4/5 Labs WBC 8,Hgb 10(baseline 13.1),Plt 350. Cr 0.9 (at baseline) BUN 19. UA color red,blood++++, protein (-), Leuk est (-), Bact +, RBCs >20,WBC 5. Patient is started on IVF, mycophenolate was held and she was admitted for further management
5/5 On day 2 hematuria persists. HIV, quantiFERON, CMV PCR, BKPyV viruria were negative.
What treatment is the most appropriate for this patient?
What treatment is the most appropriate for this patient?
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