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A patient with cough and progressive dyspnea

A patient with cough and progressive dyspnea

A 47-year-old man with HIV infection presented with progressive dyspnea and worsening productive cough for the past 3 weeks. He also reported increasingly purulent sputum production. The patient reported being adherent to his antiretroviral regimen, and he had an admission CD4+ cell count of 550/μL. He did not have any previous opportunistic infections, and he denied any drug or tobacco use, recent travel, and ill contacts.

Findings from the physical examination were unremarkable with stable vital signs. Lung sounds were clear bilaterally, but the patient was producing purulent sputum.

Laboratory values revealed a leukocytosis with a white blood cell count of 17,000/μL and a neutrophil predominance. Other laboratory findings, including toxicology screening results, were normal. A CT scan of the chest was obtained (Figure 1). The patient subsequently underwent bronchoscopy (Figure 2).

Figure 1

 

Figure 2

 

What is the likely diagnosis?  

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