A 58-year-old man with idiopathic pulmonary fibrosis is admitted to the ICU with an acute…

A 58-year-old man with idiopathic pulmonary fibrosis is admitted to the ICU with an acute exacerbation of interstitial lung disease. He reports 4 days of worsening dyspnea and dry cough, without fevers, chills, night sweats, or other associated symptoms. His examination is notable for diffuse crackles throughout inspiration. He reports that he is originally from India and moved to the United States 20 years ago, where he has lived since. He is placed on high-flow nasal cannula with FiO2 0.5 and flow of 40 L/min. Methylprednisolone 50 mg daily is administered, along with vancomycin,

A 58-year-old man with idiopathic pulmonary fibrosis is admitted to the ICU with an acute exacerbation of interstitial lung disease. He reports 4 days of worsening dyspnea and dry cough, without fevers, chills, night sweats, or other associated symptoms. His examination is notable for diffuse crackles throughout inspiration. He reports that he is originally from India and moved to the United States 20 years ago, where he has lived since. He is placed on high-flow nasal cannula with FiO2 0.5 and flow of 40 L/min. Methylprednisolone 50 mg daily is administered, along with vancomycin, ceftriaxone, and azithromycin. A chest CT reveals basilar predominant honeycombing with new superimposed multifocal ground glass opacities, along with new scattered right upper and middle lobe centrilobular nodules compared with CT scan 1 year prior. A sputum culture is obtained and sent for bacterial, fungal, and mycobacterial cultures along with acid-fast bacilli (AFB) stain. The sputum is found to have 2+ AFB. A nucleic acid amplification test (NAAT) for tuberculosis (TB) is negative. A repeat sputum sample is collected and again results with 2+ AFB and negative TB NAAT with no presence of NAAT inhibitors detected by the laboratory. What is the best next step and interpretation of this finding? A. Obtain past records of Bacille Calmette-Gu_n (BCG) vaccination as this may cause a false-negative TB PCR B. Order an interferon gamma release assay test to confirm TB infection C. Await cultures, findings indicate nontuberculous mycobacterial infection D. Await cultures, findings indicate latent tuberculosis infection E. Await cultures and start antimicrobial therapy for tuberculosis

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