Correct!
5. All of the above

The thoracic CT scan demonstrates the bilateral consolidations in the lower lungs with a normal sized heart, no cavities, no effusions and an unremarkable mediastinum. The differential diagnosis is quite large. A not uncommon problem is the finding of a positive coccioidomycosis IgM or IgG assay where other serologic tests are negative (2). In such cases, the practitioner must interpret these results in the context of how likely, in the absence of serologic data, the clinical presentation is consistent with coccidioidomycosis. Leakage of silicone from her breast implants can cause a subacute pneumonitis (3). In addition to these considerations, interstitial pneumonitis from a rheumatologic disease represents a real consideration.

Which of the following should be done at this time? (Click on the correct answer to be directed to the fourth of seven pages)

  1. Bronchoscopy with transbronchial biopsy
  2. Fluconazole
  3. Rheumatology consult
  4. 1 and 3
  5. All of the above

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