Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 60 year old woman who presents with complaint of a cough for a few months. The cough is worse in the morning. The past few mornings when she awoke she coughed up some blood. She has noted some increased shortness of breath with exertion and fatigue over the past several months as well. She reports a loss of weight of 5 pounds too, and she had not been trying to diet. She has noticed that at night she does seem to have fevers as she wakes up very sweaty. She has not noticed any chest pain or chest congestion. She states that she does occasionally suffer from seasonal allergies. She has had some headaches. She went on a trip to Southeast Asia with her husband for an anniversary gift 6 months ago.
PMH: Hypertension treated with Lisinopril. Diabetes Mellitus II treated with Metformin. Hypercholesterolemia treated with Simvastatin. No known drug allergies.
FMH: Mother had hypertension and diabetes. Father had hypertension and coronary artery disease.
PE: Sallow, ill and somewhat cachectic in appearance
VS: Height 5’5” Weight 130lb BMI 21.6 HR82 BP140/82 RR20 T98.2F
Lungs: Clear to auscultation bilaterally. Decreased breath sounds in the upper right lobe.
Lab: Chest X-ray shows multiple left upper-lobe cavities with an infiltrate in the right upper lobe.