A 65-year-old white woman with a history of COPD presents with a chief complaint of nonproductive cough and dyspnea for 3 days in February 2002. She complains of fevers, chills, dizziness, and profound weakness leading to a “fall” where she could not “get herself off the floor.” She has lost 20 lb in the past 3 months. Her medical history is notable for COPD, recurrent upper respiratory infections since the age of 14, chronic fatigue syndrome, and essential tremor. She has a family history of hereditary hemorraghic telangectasia. She lives with her mother and sister. Her medications are albuterol inhaler and theophylline. Two days prior to hospital admission, the patient’s sister (age 64 years) was admitted with acute onset of dyspnea, fever, and chills; and 1 day prior to hospital admission, her mother (age 86 years) was admitted with cough, lethargy, fever (39°C), and wheezing.