A 55-year-old male with a history of chronic obstructive pulmonary disease presents with worsening shortness of breath and a productive cough with green sputum. He also has a low-grade fever and has lost weight unintentionally over the past couple of months. What are the potential causes, and what are the next steps?
While this patient's symptoms could be due to an exacerbation of his chronic obstructive pulmonary disease, the chronic nature of his symptoms, fever, and weight loss also raise concern for tuberculosis. Other differentials could include bronchiectasis, lung abscess, or malignancy. The next steps should include sputum samples for routine culture as well as acid-fast bacilli smear and culture, and a chest X-ray. Depending on the results, further imaging studies or bronchoscopy may be needed.