A 24-Year-Old Man Comes to the Office Due to Nonproductive

A 24-year-old man comes to the office due to nonproductive cough, subjective fevers, right-sided pleuritic chest pain, and increasing dyspnea for the past 4 weeks.  He was empirically treated for pneumonia with levofloxacin at an urgent care center 2 weeks ago but has had no improvement.  The patient is an exchange student from the Philippines.  Temperature is 37.3 C (99.1 F) , blood pressure is 118/66 mm Hg, pulse is 90/min, and respirations are 20/min.  Physical examination is remarkable for decreased right-sided breath sounds.  Chest x-ray shows a large, right-sided pleural effusion.  Pleural fluid is drained, and a subsequent chest CT scan reveals right upper lobe infiltrate and calcified hilar adenopathy.  This patient's pleural fluid analysis is most likely to demonstrate which of the following findings?

A) Cytology positive for atypical cells
B) Elevated fluid triglyceride level
C) Fluid protein concentration >4.0 g/dL
D) Normal lactate dehydrogenase level
E) Predominant neutrophilic leukocytosis

Correct Answer:

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