Correct!
5. Consult palliative care
Unfortunately, therapeutic options in this patient are limited. Treatable causes of her pulmonary condition have been largely excluded. Gemcitabine is the only approved therapy for pancreatic cancer and her oncologist was reluctant to continue therapy with other agents. Open lung biopsy appears to be overly aggressive with a very low yield in identifying treatable conditions in this situation. More aggressive therapy with diuretics seems unlikely to make any major difference.
When presented with her limited options, she declined any further treatments or workup. She eventually was discharged home with her family with hospice care.
About a week after discharge final viral cultures returned positive for cytomegalovirus (CMV) and herpes simplex virus (HSV). Review of the bronchoalveolar lavage revealed no inclusion bodies present. The patient was improving without therapy so the clinical significance of these cultures is uncertain.
Which of the following patients are at high risk for CMV pneumonia?