A49 year-old man with a 25 pack-year smoking history presented to you at the
homeless clinic with complaints of increasing cough that had gradually been getting
worse over the previous six months. he noted that the sputum was blood-tinged on
one occasion. he also felt extremely tired. his x-ray showed upper lobe cavitation's
with nodular infiltrates. an acid-fast stain demonstrated slender, red rods.
click on case 1, image 1a, 1b, 1c, and 1d: image 1a chest radiograph reveals upper
lobe granulomatous disease marked by irregular reticular and nodular densities and
upper lobe cavitation due to central caseous necrosis. images 1b, 1c, and 1d
demonstrate the lung lesions at increasingly higher powers of magnification.
granulomas can be seen surrounded by epithelioid macrophages.
what disease do you suspect?