A 44-year old Hispanic man presented to a pulmonologist’s clinic after multiple failing courses of antibiotics for chronic cough for six months. History He described the recurrent scant hemoptysis and the brief migratory rash that was non-pruritic appeared on his trunk and limbs ( Figure 1 ) . Laboratory examination His physical exam was otherwise average and included no adventitious lung sounds His WBC count 4.7 cells/nL Hemoglobin 13.9 grams/dL Platelet 209 cells/nL Initial chest x-ray showed bilateral hazy diffused airspace opacities ( Figure 2 ) .
Bronchoscopy revealed no lesions throughout upper airway and lungs Before the presentation of pathologic results and cultures, the patient was presented to the emergency room with worsening dyspnea, blood tinged sputum, and rapid weight loss. He was started on HAART before initiating any other therapy due to the requirement of immune…
