Correct!
5. All of the above
The cause for her respiratory failure is not apparent. The patient is an immunocompromised host and bronchoscopy with bronchoalveolar lavage and empiric antibiotics along with blood and urine cultures are appropriate to diagnose and treat a potentially life-threatening infection. Hemodialysis was appropriate to treat her apparent congestive failure. Immunosuppressive therapy was escalated to 1 g of methylprednisolone for a possible lupus flare.
Her cultures were negative. Due to respiratory failure she was intubated and placed on a ventilator initially improving clinically and radiographically. After a few days, there was clinical deterioration and worsening chest X-ray (Figure 1).
Figure 1. Portable chest x-ray taken two weeks after admission.
She also developed a violaceous, non blanching macular rash on her buttocks and lower extremities with a few hemorrhagic bullae in a dermatomal distribution. She also developed rectal bleeding. An esophagogastroduodenoscopy (EGD) was suggestive of pseudomembranous colitis. She was started on oral vancomycin.
Which of the following is/are appropriate? (Click on the correct answer to proceed to the 3rd of 4 panels)