5. All of the above
The causes for hemoptysis after treatment for tuberculosis include recurrent tuberculosis, bronchiectasis with superimposed infection, and lung cancer (1).
The serum ß-D-glucan assay was elevated consistent with a fungal infection. He had sputum smears and cultures for tuberculosis, bacteria and fungi. The sputum smear was positive for 45◦ branching hyphae and the sputum culture grew Aspergillus fumigatus.
Further records were obtained about his prior care. A sputum culture had previously shown Aspergillus spp. which was the reason for his 6-month course of voriconazole. The hemoptysis was massive at that time consisting of several hundred mls. in less than 1 hour.
He was again placed on voriconazole and his hemoptysis initially improved. Unfortunately, his hemoptysis recurred after several days consisting of about 2 Tbsps. of clotted blood.
Which of the following are indicated at this time? (Click on the correct answer to proceed to the fourth of six pages)