Diagnostic Snapshot CHOOSE THE CORRECT DIAGNOSIS A Tumor progression B Fungal infection C Tuberculosis What is the Cause of This Patient’s Symptoms?? Figure 1 History

an, presented with a productive cough, dyspnea, and orthopnea. She was se-quentially treated with antibiotics, al-lergy medications, and steroids without symptom improvement. Chest x-ray re-vealed a widened mediastinum and right upper lobe (RUL) lesion. A CT of the tho-rax showed a 1.5 × 1.3 cm RUL lesion with slight cavitation and a 7-cm mediastinal mass causing 50 % constriction of the right mainstem bronchus. Ms. C. became profoundly hypoxic and was unable to undergo a bronchoscopic biopsy. She was transferred to a tertiary care medical center where endobronchial ultrasound-guided biopsy of the medi-astinal mass was performed; pathology demonstrated squamous cell carcinoma. Staging PET-CT done 9 days after the ini-tial CT showed an increase in the size of the RUL cavitary lesion to 2.8 × 2.2 cm and stable size of the mediastinal mass with no distant metastases. These find-ings were consistent with stage IIIB squa-mous cell lung carcinoma. Due to Ms. C.’s poor performance status, she began treatment with weekly car-boplatin/paclitaxel chemotherapy and concurrent radiation therapy. Two weeks after the start of chemoradiation, her hy-poxia and performance status improved sufficiently to allow her discharge from the hospital. She continued the radiation treatment as an outpatient, and her im-proved performance status permitted a change in the concurrent chemotherapy to the more aggressive chemotherapy regimen of cisplatin and etoposide ad-ministered every 3 weeks. Chief Complaint On day 10 of the first cycle of outpatient cisplatin/etoposide therapy (4 weeks af-ter the staging PET-CT), Ms. C. present-ed to the emergency department with fevers, hemoptysis up to 1 tablespoon, right subscapular pain rated 4/10, and progressive dyspnea