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A 34-year-old man presents to the emergency department with a 3-day history of high fever, headache, and a productive cough. He recently returned from a construction project near the Ohio River Valley. Chest X-ray shows hilar lymphadenopathy and patchy infiltrates. A bronchoalveolar lavage specimen is sent to the laboratory. A methenamine silver stain of the BAL specimen identifies the causative organism, and culture later grows mold with tuberculate macroconidia.

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