A 46-Year-Old Man Is Brought to the Emergency Department 30

A 46-year-old man is brought to the emergency department 30 minutes after being found intoxicated in a park.  The patient reports a 10-day history of fevers, night sweats, weight loss, and productive cough with foul-smelling sputum.  He drinks 1 or 2 pints of vodka daily and has been hospitalized multiple times for intoxication.  Temperature is 38.9 C (102 F) , blood pressure is 110/65 mm Hg, pulse is 102/min, and respirations are 22/min.  Lung auscultation reveals coarse crackles over the right lower lobe.  Heart sounds are normal with no murmurs.  Laboratory results show an elevated leukocyte count.  Chest x-ray reveals a cavitary lesion with an air-fluid level in the superior segment of the right lower lobe of the lung.  Which of the following is the most likely cause of this patient's lung findings?

A) Aspiration of gastric acid
B) Aspiration of oropharyngeal bacteria
C) Hematogenous spread from another focus of infection
D) Primary mycobacterial infection
E) Simple pulmonary aspergilloma

Correct Answer:

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