A 55-year-old HIV man with a CD4 count of 180 and viral load of 25,000 on highly active retroviral therapy presents with 4 days of fever and night sweats and 4 weeks of nonproductive cough. He has a...

A 55-year-old HIV man with a CD4 count of 180 and viral load of 25,000 on highly active retroviral therapy presents with 4 days of fever and night sweats and 4 weeks of nonproductive cough. He has a history of a positive PPD with negative chest x-ray. On exam, he has multiple enlarged cervical, axillary, and inguinal lymph nodes, which he had noted to be slowly growing over the last several months. Subsequent chest and abdominal x-rays reveal a mediastinal mass and a single pulmonary nodule and abdominal mass. A repeat PPD is done and is found to be negative. Which of the following is the least likely explanation for his presentation?

A. HD with anergy due to T-cell dysfunction associated with the lymphoma

B. Diffuse large B-cell lymphoma with mediastinal involvement causing nonproductive cough

C. Multiple myeloma causing T-cell dysfunction and recrudescence of tuberculosis

D. Burkitt lymphoma with several rapidly growing lymph nodes and anergy caused by advanced AIDS

E. All answers above can explain his presentation