3rd August 2023

You see a 47-year-old rice farmer from Thailand in the Acute Medicine Unit.

You see a 47-year-old rice farmer from Thailand in the Acute Medicine Unit. He presents with a 3-week history of fevers, cough, headache, arthralgia, and myalgia. He has Type 2 Diabetes Mellitus, with an HbA1C on admission of 71%.

His observations are BP 104/57, HR 109, temperature 38.3 ‘C, RR 23, spO2 93% room air, GCS 15.

Chest X-ray shows opacification at the left mid and lower zones of the lung.

3 x rapid PCR tests for Mycobacterium tuberculosis are negative. On examination, you note lymph node enlargement and multiple healed abrasions to the soles of his feet.

What investigation is likely to lead to his diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.