Correct!
1. A thoracic/abdominal CT scan is indicated
The underlying nature of the disease process is unclear at this juncture. Malaria does occur in Costa Rica although it is relatively rare. The two negative smears for malaria do not support the diagnosis. Open lung biopsy seems overly aggressive. Since the patient has received long-term corticosteroids, administration of “stress-dose” corticosteroids is prudent, but high-dose corticosteroids are not indicated in the absence of a diagnosis.
A thoracic/abdominal CT scan is indicated both because of the thoracic process and the hepatosplenomegaly (Figure 2).
Figure 2. Representative view of thoracic/abdominal CT scan.
The patient had increasing confusion and respiratory distress. Infectious disease consultation was obtained and broad-spectrum antibiotics were initiated.
Which of the following is indicated at this time?