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A 60-year-old Caucasian man is admitted to the hospital with an episode of bacterial pneumonia. Upon review of his past medical history, you notice that he has had three recent admissions within the past seven months for bacterial pneumonia. All the episodes were successfully treated with intravenous antibiotics. Previous chest x-ray comparisons reveal that the infiltrate always occurs at the right middle lobe and leaves a persistent scar. The scar was not noted on the chest x-ray prior to the episodes of pneumonia. He has a 50-pack year history of smoking. He quit smoking 10 years ago.

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Which of the following is the most likely cause of the patient's recurrent pneumonia?

A. Tuberculosis
B. Recurrent alveolar hemorrhage
C. Endobronchial obstruction
D. Congenital immunodeficiency disorder
E. Recurrent pulmonary embolism
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