Answer: B. Admit to the hospital for blood, sputum, and urine cultures and perform molecular assays for cytomegalovirus.
The possibility of cytomegalovirus (CMV) infection should be considered in a patient who has received a heart transplant presenting with fever and neutropenia. CMV can be activated by a febrile illness.1 In this case, her nephew, who is in daycare, may have exposed her to a less invasive viral illness, which in turn activated latent CMV. Her CMV status is unknown, but it is well established that heart transplant recipients with latent CMV are at the highest risk for invasive CMV infections.1 In patients presenting with invasive disease, defined as fever and leukopenia, admission to the hospital and intravenous ganciclovir is indicated once the diagnosis is confirmed.1 Molecular assays for CMV DNA in whole blood remain the best test for quantitative and qualitative analysis.1
1. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;2601-2614.