A 40-Year-Old Man Comes to the Office Due to Progressively

A 40-year-old man comes to the office due to progressively worsening shortness of breath and nonproductive cough over the last 3 weeks.  He also notes 2 months of fatigue, intermittent fever, and decreased appetite.  He has lost 6 kg (13.2 lb) during this period.  He has no other medical problems.  He has a history of intravenous drug use and a 20-pack-year smoking history.  The patient was released from a 2 year incarceration 6 months ago.  Temperature is 38.3 C (100.9 F) , blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 18/min.  The patient is in no distress but has mild temporal wasting.  Crackles are present throughout the lung fields.  Heart sounds are normal.  There is mild hepatomegaly.  Chest x-ray is shown below. What is the most likely diagnosis?

A) Hodgkin disease
B) Lung metastasis
C) Mycoplasma pneumonia
D) Septic embolism
E) Tuberculosis

Correct Answer:

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