A 77-year-old farmer presented with a 3-month history of progressive dyspnea. His symptoms started with anorexia, malaise, fever, and dry cough. He was initially treated with azithromycin and a short course of oral corticosteroids for COPD exacerbation. Two days after finishing the treatment, his symptoms progressed, and he was admitted to a local hospital with respiratory distress, altered mental status, hypotension, and abnormal chest radiograph findings. Bronchoscopy showed normal airways, and the BAL fluid sample revealed lymphocytosis with negative culture results. The patient was treated with doxycycline, ceftriaxone, and corticosteroids for presumed hypersensitivity pneumonitis and showed some improvement. He was subsequently discharged from the hospital while receiving therapy with prednisone, 20 mg. Five days later, he was readmitted to the hospital with worsening malaise, fever, altered mental status, and severe respiratory distress that required mechanical ventilation. He was then transferred to our facility for further management.