A disease with many faces

A 31-year-old black man, previously resident in Angola, was referred to our hospital complaining of 6 months of progressively worsening shortness of breath with exertion and mucous productive cough. During this period, he had a significant weight loss (about 10 kg) and fatigue. His past medical history included suspected pulmonary tuberculosis (TB), for which he had completed 6 months of anti-bacillary treatment in the year before. He is a construction worker and a nonsmoker, with no other environmental exposure or medication. The physical examination was remarkable for slight tachycardia (heart rate 105 beats·min −1 ), tachypnoea (respiratory rate 20 cycles·min −1 ), oxygen saturation of 94% and bilateral inspiratory crackles on both lungs. Figure 1 shows the chest radiograph. Can you diagnose this man with progressively worsening shortness of breath, mucous productive cough, weight loss, fatigue and a history of suspected pulmonary tuberculosis? http://bit.ly/2VUdnTr