A 43-Year-Old Construction Worker Comes to the Physician with Intermittent

A 43-year-old construction worker comes to the physician with intermittent fever, cough, and shortness of breath over the last 4 months.  He also complains of night sweats and reports a 4.5-kg (10-lb) weight loss.  He has no hemoptysis.  The patient has no medical problems and does not use tobacco, alcohol, or illicit drugs.
Bilateral scattered wheezes are heard on physical examination.  There are no cardiac murmurs.  The spleen is not palpable, and there are no skin rashes or lymphadenopathy.
Rapid HIV test is negative.  Chest x-ray reveals bilateral pleural-based dense infiltrates involving upper and lower lobes.  The infiltrates spare the central and perihilar lung regions.
Which of the following is the most likely diagnosis?

A) Asbestosis
B) Eosinophilic pneumonia
C) Idiopathic pulmonary fibrosis
D) Pulmonary alveolar proteinosis

Correct Answer:

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