A 47-year-old, African-American man presented to the emergency department complaining of 3 weeks of cough, fever, and night sweats. The cough was productive of white sputum and progressive in nature. The patient also noted 3 days of severe dyspnea and several episodes of posttussive syncope. He had fatigue and malaise but no other symptoms. Doxycycline prescribed 4 days prior had not alleviated the symptoms.
The patient had a 12-year history of ulcerative colitis for which he had required hospitalization on several occasions. A recent colonoscopy demonstrated active disease. His current medications included oral mesalamine and doxycycline. He was a former smoker but quit 3 years prior. He denied recent travel and had no risk factors for tuberculosis. There was no family history of GI or pulmonary disease.