Correct!
4. A + C
In the Southwest coccidioidomycosis is certainly a possibility. Although the presentation and chest x-ray are not classic, an atypical presentation of pulmonary edema is possible. There are no reports to our knowledge of a similar presentation 4 weeks after DPT vaccination.
His laboratory evaluation included a complete blood count showing a hemoglobin of 13.6 g/dL and a hematocrit of 40.9%. His white blood cell count was 10.3 X106 cells/microliter. Differential showed no left shift but his eosinophils were slightly elevated at 5.2% or an absolute count of 530 cells/microliter. His N-terminal pro-brain naturetic peptide (NT-proBNP) was also slightly elevated 290. His INR was elevated at 2.53 compatible with his warfarin therapy. His cocci serology was negative.
To better define his thoracic lesions a CT scan of the chest was performed (Figure 2).
Figure 2. Representative images from the thoracic CT scan. Click here for a movie of the CT scan
Which of the following should be done next?
