Correct!
5. All of the above
Now that he has a stable airway, bronchoscopy can be safely performed. Bronchoscopy was unremarkable with BAL showing a neutrophil predominant cellularity. Smears for bacteria were negative. Cold agglutinins were negative. The patient’s chest x-ray is not typical of tuberculosis, although tuberculosis can manifest acutely, resembling severe pneumonia (1). It would be unusual for tuberculosis to manifest as an acute pneumonia while on isoniazid.
An acute pneumonia picture can be particularly challenging in regions with a high prevalence of tuberculosis, as the similarity in symptoms can lead to misdiagnosis and delayed treatment. Although Myanmar has a high incidence of tuberculosis, Nebraska does not. Isoniazid has also been reported to cause an acute pneumonitis (2).
He improved rapidly; extubated; and discharged to home. The initial conclusion of his primary care physician was his clinical picture was likely from his workplace exposure and he was advised not to return to work.
How would you investigate workplace exposure as a cause of the diffuse pneumonia? (Click on the correct answer to be directed to the fifth of 6 pages)