A 62-Year-Old Man with Limited, Unresectable Small Cell Lung Cancer

A 62-year-old man with limited, unresectable small cell lung cancer comes to the emergency department because of fever for the past 2 days. He has been on numerous chemotherapy regimens. His last round of treatment was with cisplatin and etoposide and ended 10 days ago. He feels fatigued but has not had nausea or vomiting. He appears ill. His temperature is 38.5°C (101.3°F) , pulse is 115/min, and blood pressure is 100/60 mm Hg. Physical examination shows dry mucous membranes. His hemoglobin level is 9.5 g/dL, and leukocyte count is 900/mm³ with an absolute neutrophil count of 100/mm³.  Chest x-ray reveals a dense infiltrate involving the right upper lung lobe.  Broad-spectrum antibiotic therapy is instituted.  Five days later, the patient is still febrile.  Bronchoscopy with biopsy is performed and the tissue samples from the bronchoscopy grow mold.  Which of the following organisms is most likely responsible for this patient's current condition?

A) Aspergillus fumigatus
B) Candida albicans
C) Cryptococcus neoformans
D) Pneumocystis jirovecii
E) Rhizopus oryzae

Correct Answer:

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