17th February 2025

A 40-year-old woman has a renal transplant for polycystic kidney disease.

A 40-year-old woman has a renal transplant for polycystic kidney disease. Subsequently, she develops a dry cough and retinitis.

Observations are as follows: oxygen saturation 87% on room air, temperature 38.5°C.

Investigations are as follows:

Haemoglobin 90 (120 – 170)

White cell count 18.2 (4 -11)

Platelets 220 (150 – 450)

Mean cell volume 86 (80 – 100)

Sodium 137 (135-145)

Potassium 5.9 (3.5 – 5.5)

Urea 8.2 (2.5 – 7.8)

Creatinine 180 (59 – 104)

Alanine phosphatase 89 (30 – 130)

Alanine aminotransferase 252  (<41)

Aspartate aminotransferase 145 (<45)

Bilirubin 14 (<21)

CRP 105 (<5)

What is the most appropriate treatment?

Select the SINGLE most appropriate option from the list below. Select ONE option only.