ID Fellows Cup Question 6

A 55-year-old woman with hyperlipidemia presents to the Emergency Room complaining of several episodes of hemoptysis over the past 24 hours. In the past several weeks she has also experienced night sweats, myalgias/arthralgias, fatigue, and a 10 lb weight loss. She reports progressive dyspnea in the preceding 6 months following treatment for sinusitis at an urgent care. She takes albuterol as needed for possible reactive airway disease. She lives in Missouri and denies international travel. She is a current smoker with a 20 pack-year history and denies other drug or alcohol use. On initial evaluation, she is afebrile with stable vital signs. She has blood crusting around her nares bilaterally. Initial lab workup demonstrates acute renal injury with a creatinine of 2.8 mg/dL, from a baseline of 0.9 mg/dL. A CT scan of the chest is performed and is shown below:

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