A 25-year-old African-American woman with a chief complaint of progressive dyspnea and cough presented to the inpatient service after her primary care physician noted a significant right-sided pleural effusion on a chest radiograph. She had a 2- to 3-year history of intermittent, sharp, pleuritic chest pain radiating from the right subscapular region, across the anterior chest, and down the right arm that worsened with cough and accompanied this episode. Three months prior to hospital admission, dyspnea had developed with exertion and cough productive of white sputum. She sought medical attention 2 months prior to hospital admission, but two courses of outpatient antibiotic therapy did not ameliorate her condition. Her activity level deteriorated from unrestricted walking to dyspnea at rest.