Review Question - QID 109048

A 28-year-old male presents to the emergency department with fever and cough. He reports that two days ago he developed a productive cough with associated shortness of breath. He also endorses drenching sweats for the last several nights. The patient’s past medical history is otherwise significant for Crohn's disease for which he has been taking prednisone for the past several months. He reports that the symptoms of his Crohn's disease have largely remitted since being on the prednisone. He has a 10-pack-year smoking history and drinks 2-3 beers a few nights per week. He is sexually active with a male partner and has a recent negative HIV test. The patient’s temperature is 101.0°F (38.3°C), blood pressure is 121/68 mmHg, pulse is 110/min, and respirations are 22/min. On physical exam, he is in moderate distress and tachypneic. He has crackles and rales throughout the right middle and lower lung zones. His chest radiograph can be seen in Figure A. Gram stain of a sample obtained from a bronchoalveolar lavage can be seen in Figure B.
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