Chest Pain and a Cavitary Lung Mass in a Woman With Diabetes

A woman from the Southeastern US with a history of smoking, poorly controlled diabetes, and inhalational medical marijuana use had 4 months of productive cough, weight loss, subjective fevers, 3 days of worsening chest pain, and a large right upper lobe cavitary mass on chest CT unresponsive to antibiotics. AFB smear and GeneXpert MTB/RIF testing were negative; she developed a right-sided tension pneumothorax after intubation for hypoxemia, and chest tube placement yielded charcoal-colored pleural fluid. What is the diagnosis and what would you do next?
Source: JAMA - Journal of the American Medical Association - Category: General Medicine Source Type: research