Correct!
1. Bone marrow biopsy

The diagnosis remains unclear. A liver biopsy has some risk with the prolonged prothrombin time and low platelets. Mini-thoracotomy and VATS would seem unlikely to reveal additional information to that already obtained and there is no indication for a brain biopsy.

A bone marrow biopsy was performed on hospital day 2 because of the persistent pancytopenia. It revealed budding yeast. (Figure 4).  

Figure 4. Bone marrow biopsy showing small budding yeast.

Which of the following are not appropriate at this time?

  1. Bone marrow culture
  2. Coccidioides serology
  3. Histoplasma urinary antigen
  4. Begin amphotericin B
  5. Begin fluconazole

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