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1. Auto-Immune Disorder, Pulmonary Edema, Community Acquired Pneumonia, Coccidioidomycosis
The patient does not have risk factors concerning for tuberculosis and his physical exam findings make malignancy an improbable diagnosis. Although he has a history of long distance travel, his hypoxia of apparent 2 weeks duration makes the diagnosis of pulmonary embolism very unlikely. This patient’s presentation is not at all supportive for typical hydatid cyst disease.
Based on the CXR he could have an unresolving pneumonia. Given the geographical location where the patient lives coccidioidomycosis is a serious consideration. Elevated inflammatory markers are supportive of a possible auto-immune process and intermittent swelling might suggest a possible cardiac etiology which makes pulmonary edema possible based on the CXR findings.
To find the definitive etiology of this patient’s pathology the most appropriate tests would include? (Click on the correct answer to proceed to the 4th of 6 panels)