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Rheumatoid arthritis — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologyRheumatoid arthritisABIM Board

A pet-shop employee develops high fever, severe headache, dry cough, relative bradycardia, mild hepatitis, and patchy pneumonia after cleaning parrot cages. Routine sputum culture is unrevealing and no beta-lactam allergy is present. Which empiric treatment is most appropriate?

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Correct answer: C — Begin doxycycline for suspected psittacosis while arranging diagnostic testing

The best answer is “Begin doxycycline for suspected psittacosis while arranging diagnostic testing”. The bird exposure and atypical systemic pneumonia are characteristic of psittacosis caused by Chlamydia psittaci. Doxycycline is preferred treatment in adults and should not be delayed for paired serology or specialized molecular confirmation when clinical suspicion is high. Beta-lactams do not reliably treat this obligate intracellular pathogen. Influenza remains a differential diagnosis but does not make oseltamivir the only exposure-linked therapy, and delayed treatment can permit severe disease.

Reference: CDC: About Psittacosis: https://www.cdc.gov/pneumonia/about/about-psittacosis.html