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What’s Causing This Persistent Cough?

A 75-year-old female presents with a two-year history of a persistent cough and fatigue. The cough is occasionally productive of purulent sputum. She was treated for a community-acquired pneumonia two years earlier and underwent an anterior cervical discectomy and fusion previously, but is otherwise well. On examination, she appears well-groomed, polite, and thin. Chest auscultation reveals wheezing in the mid zones bilaterally and a later chest X-ray and CT scan demonstrate the findings seen here.

a. Klebsiella pneumoniae
b. Pseudomonas aeruginosa
c. Aspergillus fumigatus
d. Mycobacterium avium-intracellulare

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