Correct!
5. All of the above.

There was an increase in eosinophils noted in bronchoalveolar lavage fluid in this case; however, the percentage of eosinophils was nonspecific and some increase in lavage eosinophils can be seen in each of the listed disorders.  Therefore, a VATS lung biopsy was performed to confirm a diagnosis (Figure 3).

Figure 3. VATS lung biopsy from upper lobe (Panels A & B) and lower lobe (Panels C & D). A high power view is shown from each (Panels B & D).

What should be done next?

  1. Stop all the patient's drugs
  2. Begin amphotericin B
  3. Begin ivermectin
  4. Begin prednisone
  5. Begin prednisone, azathioprine and N-acetylcysteine