Case 199

Medical history

Female patient, 53 years old, former smoker, with diabetes and hypertension, admitted to the HC-UFMG complaining of non-productive cough, dyspnea on moderate efforts and low-grade fever, as well as weight loss (2 kg) in the last 2 months. Reports empirical treatment for atypical community-acquired pneumonia with azithromycin, after performing chest radiography (attached), about one month and a half ago, with no improvement. Physical examination shows SpO2 87% in room air and creptations in right infrascapular region. AFB smear research was done in the sputum, the first sample was negative. It was requested high resolution computerized tomography (HRCT), presented below.

What is the main diagnosis and the most appropriate management?

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