Case 45 A 39 years old homeless man present to the emergency department for cough and fever.

He say that his illness has been worsening over the past to weeks. He orginalynhad dypsnea on exertion and now is short of breath at rest. On questioning, he tell you that he lives in a homeless shelter when he can, but he frequenty sleep on the streets. He has used IV drugs (primarily heroin) on and off for many years. He denies medical history but the only time he gats medical attention is when he comes to the emergency depertement for an illness or injury. On review of systemis, he complains of fatigue, weigh loss, and diarrhea. On examination he is a thin, disheveld man appearing much older than his stated age. His temperature is 100.5 F (38.0 C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. his initial oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tacycardic but regular radiac rhythm, a begin abdomen, and generally wastedappearing extremities. his pulmonary examination is significant for tachypnea and fine crakles bilaterally, but no visible sign of cyanosis. His chest x-ray is read by the radiologist as having difusse, bilateral, intertisial infiltrates thats look like groud galss What is the most likely cause of this patients current pulmonary complaint? What anderlying illness does this patient most likely have? What testing and treatment should be startet now?