A 12-year-old boy presents with three weeks of daily fevers, significant abdominal pain, and a 3kg (6.6lb) weight loss. He has a new kitten at home. An abdominal CT scan reveals multiple hypodense lesions throughout his liver and spleen. A diagnosis of disseminated cat scratch disease is made. Which antimicrobial regimen has been shown to have the best clinical response for this hepatosplenic presentation?
An 11-year-old girl from Wisconsin is seen in August for high fever, severe headache, and myalgias. A physical exam reveals a 10 cm annular, erythematous rash with central clearing on her back. Laboratory studies show leukopenia, thrombocytopenia, and elevated liver transaminases. What single oral antibiotic is the most appropriate choice to treat all of her likely infections?
A neonate is born at 39 weeks gestation to a mother who developed a varicella rash 3 days before delivery. The mother has not yet developed a significant antibody response. What is the most significant risk for this infant, and what is the recommended immediate management?
A 4-year-old child presents with a chronic, non-healing 2 cm ulcerative lesion on his cheek after a family trip to rural Brazil. A biopsy confirms cutaneous leishmaniasis. Speciation is pending. Why is systemic treatment indicated rather than observation?
A 14-year-old with inflammatory bowel disease develops severe Clostridioides difficile infection and is treated with a 10-day course of oral vancomycin. Two weeks later, his symptoms recur. He is treated with another 10-day course of vancomycin, but symptoms return again 3 weeks after finishing the second course. What is the most appropriate next step in management for this second recurrence?
A full-term, asymptomatic neonate is born to a mother who had no prenatal care and was found to have a reactive RPR of 1:128 and a positive TP-PA test at delivery. The infant’s quantitative RPR titer is 1:512. Which of the following is the most appropriate management for this infant?
A 4-year-old boy who received a liver transplant 6 months ago presents with fever, lymphadenopathy, and rising Epstein-Barr virus DNA levels in his blood. A diagnosis of post-transplant lymphoproliferative disease (PTLD) is considered. What is the most important risk factor for the development of this condition?
A 14-year-old boy is treated for severe Plasmodium falciparum malaria with intravenous artesunate. He responds well and is discharged. Which follow-up monitoring is crucial for this specific medication in the weeks following treatment?
A 3-year-old child presents with a 2-week history of progressive irritability, low-grade fever, and vomiting, and is now lethargic with nuchal rigidity. A lumbar puncture is performed. Which set of cerebrospinal fluid (CSF) findings is most characteristic of tuberculous meningitis?
A 12-year-old with Acquired Immunodeficiency Syndrome (AIDS) with a CD4+ count of 50 cells/μL presents with a headache and confusion. A lumbar puncture reveals an opening pressure of 30 cm H₂O and the cerebrospinal fluid is positive for cryptococcal antigen. In addition to antifungal therapy, what is the most critical initial management step for this patient’s increased intracranial pressure?
