Correct!
4. 1 and 3
The patient has some symptoms suggestive of pneumonia but does not appear terribly ill. In this situation a sputum Gram stain and culture and empiric antibiotics is appropriate. Although bronchoscopy with bronchoalveolar lavage can be used to obtain lower respiratory tract cultures, it is invasive and seems overly aggressive at this time in this non-immunocompromised patient.
A sputum Gram stain was unremarkable and the patient was begun on levofloxacin. His sputum culture was eventually reported as showing no growth. Three days later he calls and complains of a rash (Figure 2).
Figure 2. Photographs of the patients macular rash. The rash also extended into the groin area.
Which of the following is the most likely cause of the patient's rash? (Click on the correct answer to proceed to the third of four panels)