A 20 year-old African American man comes to your office and reports fever, chill, abdominal pain and dyspnea. He developed chest pain three days ago that is progressively getting worse and back pain and leg pain this evening. His medical history is significant for sickle cell disease. He had abdominal surgery in the same hospital for recurrent hernia 10 days ago. He smokes one pack of cigarettes every day and has a history of asthma, controlled with an albuterol inhaler used on an as needed basis. He has a fever of 104⁰ F, blood pressure 110/70 mm Hg, pulse 114/minute. He has tachypnea with a respiratory rate of 37/minute and an oxygen saturation of 89% on room air. In physical examination, you see an anxious individual with increased work of breathing; hear bilateral wheezing and rales on auscultation. A chest x-ray revealed an infiltrate in the middle lobe of the right lung and an alveolar consolidation in the superior lobe of the left lung. There is no atelectasis. You reviewed the records of his most recent stay in the hospital and his chest x-ray done as part of his preoperative protocol was normal during that visit. Induced sputum test revealed lipid-laden macrophages, which are Oil Red O–positive. What is the most likely diagnosis in this patient?
