A 25-year-old African-American woman presented to the ambulatory clinic with nonproductive cough, fever, and weight loss. A tuberculin skin test result was negative, and chest radiography showed a right upper lobe infiltrate (Fig 1
). She was the mother of two children, and she had been in a monogamous relationship for the past 2 years. She denied the use of tobacco or illicit drugs, and reported having a negative HIV test result 1 year before. She reported a 1-week trip to rural southeastern Virginia 2 months before the onset of symptoms.