A 7-year-old boy is admitted to the hospital because of a 2-month illness consisting of cough, progressive shortness of breath, loss of appetite, and weight loss. Two years ago he was admitted for a similar illness, which was diagnosed as miliary tuberculosis and was treated with four drugs. Both symptoms and radiographic findings resolved completely. There had been a possible previous exposure to tuberculosis on a visit to Pakistan.

On physical examination, the child looks well and is afebrile. Auscultation reveals bilateral wheezing and diffuse rales. Cardiac and abdominal examinations yield normal findings. The boy requires 28%oxygen by mask to maintain pulse oximetry readings above 95%.

Results of a complete blood count are normal, but his erythrocyte sedimentation rate is 25 mm/h. A radiograph of his chest shows diffuse bilateral interstitial infiltrates and a normal cardiac silhouette. Computed tomography of the chest shows fine micronodularity and interstitial infiltrates. A purified...

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