A 50-Year-Old Man Comes to the Office Due to Lightheadedness

A 50-year-old man comes to the office due to lightheadedness and fatigue for the last several weeks.  Over the last few days, he has become lightheaded when standing up.  He has also experienced subjective fevers and a daily cough for the past 3 months and has lost 8 kg (17.6 lb) during that time.  The patient has no known medical history.  He does not use tobacco, alcohol, or illicit drugs and takes no medications.  He immigrated from Southeast Asia 25 years ago and occasionally makes trips back there to visit family.  Temperature is 38 C (100.4 F) , blood pressure is 96/62 mm Hg, pulse is 98/min and regular, and respirations are 14/min.  Oxygen saturation is 94% on room air.  On physical examination, the neck veins are flat.  Laboratory results are as follows: Chest x-ray reveals patchy airspace disease in the left upper lung lobe as well as mediastinal lymphadenopathy.  Which of the following is most likely responsible for this patient's lightheadedness?

A) Hypothalamic infiltrative lesion
B) Infectious adrenalitis
C) Mycobacterial pericarditis
D) Paraneoplastic syndrome
E) Pulmonary strongyloidiasis

Correct Answer:

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