A 50-year-old man is admitted to the hospital with fever and a head ache. The patient has a medical history of human immunodeficiency virus (HIV) and hepatitis C. The patient reports a 20-pack-per-year smoking history and that he stopped smoking 5 years ago. During his last physician visit 3 months earlier, he was treated for a fever and cough. Chest x-rays are obtained on his present admission.

Computed tomography (CT) scans of the chest are recommended to delineate the mass and examine the mediastinum for enlarged lymph nodes.

Sputum cultures and Mantoux purified protein derivative (PPD) skin test.

The Mantoux PPD skin test is negative, and the sputum cultures demonstrate no growth. Because of continuing febrile episodes and no source of infection, a recommendation is made by the infectious disease service to obtain a percutaneous needle biopsy for histology and culture. The biopsy is performed under CT guidance, but histologic evaluation is not diagnostic. After the procedure, the patient is short of breath, with decreased breath sounds over the left lung field. Chest xray shows a 30% pneumothorax on the left side. The patient undergoes a pigtail catheter placement.