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Transfusion-related acute lung injury — ABIM Board MCQ

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HardPulmonary/Critical CareTransfusion-related acute lung injuryABIM Board

A landscaper develops fever, painful regional lymphadenopathy, an ulcer at the site of a tick bite, hypotension, acute kidney injury, and bilateral pulmonary infiltrates. Francisella tularensis is suspected and blood cultures were collected with laboratory notification. Which initial antimicrobial regimen is preferred?

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Correct answer: E — Begin parenteral gentamicin with renal and drug-level monitoring

The best answer is “Begin parenteral gentamicin with renal and drug-level monitoring”. The shock, pulmonary involvement, and organ dysfunction make this severe tularemia. CDC recommendations favor initial aminoglycoside therapy, commonly gentamicin, when possible; renal function and concentrations require monitoring. Doxycycline can treat selected nonsevere illness but a seven-day oral course is inadequate here. Beta-lactams, macrolides, and trimethoprim-sulfamethoxazole do not provide dependable definitive treatment for severe Francisella infection.

Reference: CDC 2025 Tularemia Antimicrobial-Treatment Recommendations: https://www.cdc.gov/mmwr/volumes/74/rr/rr7402a1.htm