The differential diagnosis should include bronchitis, pneumonia,
tuberculosis, and neoplasm.  However,
this scenario smacks of tuberculosis.  Tests
ordered should include PPD, sputum AFB smears and culture, chest x-ray, CBC and
possibly blood chemistries.  A
negative PPD is possible because of chronic steroid use and would not rule TB.
In fact, chronic steroid use enhances reactivation of TB and therefore
increases this individual’s risk of disease.
If the chest x-ray and sputum cultures were not consistent with acute
pneumonia or bronchitis (the history already suggests some chronicity),
initiation of therapy pending culture results would be prudent.