A 46 years old man presents with fever, cough productive of copious sputum with a putrid odor, and malaise. He is unable to assign the exact onset of his symptoms but claims they have developed over at least 1 month. He lives alone and is a long-time smoker with a history of chronic alcohol abuse. He also reports the occasional use of illicit drugs. On physical exam, he looks profoundly malnourished and his dental hygiene is very poor. Auscultation of the chest reveals fixed breath sounds over the right hemothorax. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out lung cancer, Wegener’s granulomatosis, and infection (tuberculosis, fungal pneumonia).

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This post was written by Omar Rifai