A 54-year-old man comes to the physician for a 3-week history of persistent productive cough, foul-smelling sputum, low-grade fever, and fatigue. For the past 2 days, he now reports night sweats and some sharp chest pain. Past medical history is otherwise unremarkable apart from on-and-off heavy drinking. A chest x-ray and CT are performed.
What is the most appropriate next step in management?
A) Bronchoscopy with transbronchial biopsy
B) CT-guided percutaneous drainage
C) Intravenous clindamycin therapy
D) Lobectomy
E) Sputum cytology for malignant cells
