<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 38-year-old man comes to the physician because of fever, malaise, productive cough, and left-sided chest pain for 2 weeks. During this time, he has woken up to a wet pillow in the morning on multiple occasions and has not been as hungry as usual. He was diagnosed with HIV infection 1 year ago. He currently stays at a homeless shelter. He has smoked one pack of cigarettes daily for 22 years. He has a history of intravenous illicit drug use. He drinks 56 beers daily. He is receiving combined antiretroviral therapy but sometimes misses doses. His temperature is 38.6C 101.5F, pulse is 106min, and blood pressure is 12585 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94. Auscultation shows decreased breath sounds over the left base of the lung. There is dullness to percussion on the left lower part of the chest. Laboratory studies show:Hemoglobin 14 gdLLeukocyte count 5,000mm3CD4 T lymphocytes 240mm3 N 500SerumCreatinine 0.9 mgdLγ-Glutamyltransferase GGT 65 UL N 550Aspartate aminotransferase AST 15 ULAlanine aminotransferase ALT 19 ULAlkaline phosphatase 40 ULLactate dehydrogenase LDH 50 ULAn x-ray of the chest shows a left-sided pleural effusion and hilar lymphadenopathy. Analysis of the pleural fluid shows an effusion with lymphocyte-predominant leukocytosis, high protein, an LDH of 500 UL, and high adenosine deaminase. Which of the following is the most likely cause of this patients condition?? A: Cirrhosis, B: Rheumatoid arthritis, C: Pneumocystis jirovecii pneumonia, D: Lung cancer, E: Pulmonary tuberculosisn,  <response>: This is a patient with HIVAIDS who presents with fever, cough, chest pain, and pleural effusion. Key findings include HIV infection, low CD4 count indicating advanced immunosuppression, history of smoking and IV drug use, lymphocyte-predominant pleural effusion with high protein, LDH and adenosine deaminase. The main differential diagnosis includes opportunistic infections like Pneumocystis jirovecii pneumonia, pulmonary tuberculosis, and lung cancer. Cirrhosis and rheumatoid arthritis are less likely given the clinical presentation. Pulmonary tuberculosis is the most likely diagnosis given the lymphocyte-predominant effusion with high adenosine deaminase levels, in an immunocompromised patient with risk factors like homelessness, smoking and IV drug use. Pneumocystis pneumonia is less likely with the lymphocyte predominance and lack of hypoxemia. Lung cancer could cause effusion but is less likely in his age group.E: Pulmonary tuberculosis 