Mr X, 51 years of age, has a 30-year history of Crohn's disease. He has undergone 2 ileal resections in the past, the last one occurring 8 years ago. He has been receiving treatment with 6-mercaptopurine and adalimumab (Humira) since. He has lived in the northeast United States his entire life and traveled to Brazil, Uruguay, and Argentina 2 years ago.
Mr X developed fever and cough 2 weeks before presentation; chest radiograph showed a right lower lobe nodular density. Computed tomography of the chest confirmed a right lower lobe consolidation, as well as hilar and paratracheal lymphadenopathy. Positron emission tomography showed fluorodeoxyglucose-avid mediastinal and portocaval lymph nodes. Routine laboratory evaluation was normal except for an alanine aminotransferase level of 80 U/L and an erythrocyte sedimentation rate of 30 mm/h. QuantiFERON gold test was negative for history of exposure to Mycobacterium tuberculosis.
Which one of the following is the most likely diagnosis?
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