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4. 1 and 3
The cause of the pneumonia is unclear. The patient is immunocompromised from the prednisone and azathioprine used to treat her rheumatologic condition. Salmonella could possibly be a cause of her pneumonia but this organism would be unusual. Influenza remains a possibility. A decision is made to proceed with the bronchoscopy.
Bronchoscopy reveals unremarkable bronchi and bronchoalveolar lavage is performed. The lavage fluid has a neutrophilia with >90% of the cells being polymorphonuclear neutrophils (PMNs). Culture results are reported as showing a beaded, branching, Gram positive, partially acid fast, aerobic, non-motile bacteria characteristic of Nocardia sp.
What should be done at this time? (Click on the correct answer to proceed to the sixth and final page)