system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 40-year-old chronic smoker presents to the office complaining of a cough and pleuritic chest pain. He also has had pain in his right shoulder for the past 2 weeks. He denies fever, night sweats, but has noticed a 2.2 kg (5 lb) weight loss in the last month. He has no recent history of travel. Past medical history is unremarkable. On cardiopulmonary examination, bilateral velcro-like crackles are auscultated in the upper to middle lung fields, with normal heart sounds. There is a 3 x 3 cm swelling on the right shoulder with a normal range of motion and intact sensation. 5/5 muscular strength in all extremities is noted. Chest X-ray reveals bilateral nodular opacities in the upper lung lobes and a lytic lesion on the right humeral head. Electron microscopy of the lung biopsy shows the following. Which of the following is the most likely diagnosis?
assistant
Histiocytosis X