Correct
4. 1 and 3
Corticosteroids worked well previously and a second course was begun. We would not treat with an alternative anti-inflammatory therapy such as cyclophosphamide, cyclosporine or mycophenolate unless corticosteroids failed. A serum hypersensitivity panel was ordered and the patient tested positive for pigeons.
Close questioning revealed that he had a pigeon he kept indoors. He had found the bird in his yard and considered him a rescue, not a pet. In retrospect, rather than asking about pets in the home, it would have been better to ask him directly if he had a bird living in his house.
The pigeon was removed and the corticosteroids tapered. He made a full and uneventful recovery.
References