A 39-year-old man presented to the emergency department with a 2-week history of mild abdominal pain, abdominal distention, and dyspnea. He had a nonproductive cough with sharp chest pain, chills, night sweats, anorexia, and early satiety. A 20-lb weight gain with bilateral lower extremity swelling was also reported. An outpatient course of doxycycline had failed to improve his symptoms. His medical and social history were otherwise unremarkable.
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