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Based on these non-specific CT findings there is a broad differential diagnosis and additional clinical information is mandatory for the interpretion of the HRCT.
Since this patient is a smoker we first think RB-ILD.
In a immunocompromised patient PCP would be on top of the list.
If this patient was coughing up blood, this probably would be pulmonary hemorrhage (although we would expect more pulmonary densities in these patients).
If this patient was a bird-fancier we would first think hypersensitivity pneumonitis, but mostly these patients do not smoke.

Times have drastically changed. Enterococcus faecalis and E. faecium are now major nosocomial (hospital acquired) pathogens and some of the most antibiotic resistant bacteria that we deal with. Vancomycin resistant Enterococci (VRE) are an extremely serious threat and one of the first widespread examples of “re-entering the pre-antibiotic era” in which we have little or no effective antibiotic therapy available for serious infections. This is an excellent example of the need for extremely prudent antibiotic prescribing practices.

Lymphangitic spread steroids

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