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A 60 year old female  patient with AIDS] with a CD 4 count of 126 from the Mississippi River valleys. Presents with fever, worsening cough, weight loss, malaise, and dyspnea. The patient also had symptoms of diarrhea and abdominal pain. 

You note signs of bowel obstruction on physical examination (ie distended abdomen).

Which of the following is the most likely diagnosis?