A 46-Year-Old, Previously Healthy Man Develops Sudden-Onset, Sharp, Left-Sided Flank

A 46-year-old, previously healthy man develops sudden-onset, sharp, left-sided flank pain radiating to the groin.  CT scan of the abdomen reveals a left ureteral calculus, which he passes spontaneously in the urine.  Other, incidental findings include a left lower lobe lung nodule and foci of calcifications in the spleen.  Chest imaging shows several small calcified nodules in both lungs and a calcified mediastinal lymph node.  The patient has had no pulmonary symptoms and is a lifelong nonsmoker.  He is a farmer who lives in Ohio and has not traveled recently.  Physical examination shows no abnormalities.  Tuberculosis skin test shows a <5 mm induration at 48 hours.  Repeat chest imaging 3 months later reveals no changes.  Which of the following is the most likely cause of the observed findings in this patient?

A) Fungal infection
B) Metastatic cancer
C) Miliary tuberculosis
D) Parathyroid adenoma
E) Silica exposure

Correct Answer:

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