Asthma USMLE Step 1 Practice Question

A 34-year-old woman with a 12-year history of moderate persistent asthma presents to the emergency department with acute-onset severe dyspnea, unilateral left pleuritic chest pain, and hemoptysis. She reports a 3-week prodrome of low-grade fever, malaise, and progressive dyspnea despite adherence to her inhaled corticosteroid and long-acting beta-agonist. Vital signs: BP 128/82 mmHg, HR 118 bpm, RR 28/min, SpO2 88% on 2L nasal cannula. She denies recent trauma, immobilization, or oral contraceptive use. Physical examination reveals decreased breath sounds at the left lung base with crackles. Chest X-ray shows a new left lower lobe consolidation with bronchial wall thickening. Laboratory studies: WBC 11,200/μL, IgE 680 IU/mL (normal <100), serum eosinophils 8% (normal <4%). Sputum cultures are pending. Which of the following complications most likely explains her clinical presentation?