[Expert Solution]: A 28-year-old Caucasian male with past…

A 28-year-old Caucasian male with past medical history significant for intravenous (IV) substance abuse presented to the emergency room complaining of a productive cough, chest pain, fever, chills, sweats, vomiting, and diarrhea for 4 days. He has a retrosternal chest pain that radiates to his back and worsens with inspiration and lying down. He also complains of diffuse muscle soreness, fatigue, shortness of breath, and chest tightness. He denied any history of travelling outside United States, prison time, or exposure to tuberculosis. Past surgical history was significant for an abscessed tooth extraction 2 months prior. He was not receiving any medications prior to this encounter. Family history was significant for history of methicillin-resistant Staphylococcus aureus (MRSA) skin abscesses in his sister. Substance abuse history was significant for smoking marijuana starting at age 15, smoking methamphetamine starting at age 18, and IV use of methamphetamine starting at age 26. He also reported being clean of any illicit drug use for the last 11 months.Physical ExaminationHis vital signs were: temperature of 102.8deg F, pulse of 133 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 140/72 mm Hg, and oxygen saturation of 93% on room air. On physical examination, the patient had tachycardia with normal rhythm, normal S1, and fixed S2 split. There was decrease in breath sounds in right upper lesion and significant use of accessory muscles for breathing. There were 3 distinct lesions along the lining of a new 11 day old tattoo (Figure 1). One of which was approximately 2.5 cm by 2.5 cm in size with a scabbed head. Laboratory TestingPeripheral Blood smear with Giemsar/Wright Staining and CXR are shown below.Troponin studies were negative for acute coronary syndrome. HIV and Hepatitis B tests were negative. Abscess on patients back was drained and sent for culture and Pulmonology was consulted for a diagnostic bronchoscopy and lavage which was not significant; sputum acid-fast bacilli (AFB) and blood culture with Gram stain and cytology were ordered to identify specific pathogen.(2) Is his CXR normal? What might be happening in area 1 and 2? ( 2 points)