An 88-year-old woman with diabetes, hypertension, and rheumatoid arthritis presented with dyspnea and weakness for 5 months. Three months prior, she was hospitalized for pneumonia with steroid treatment initiated for presumed obstructive airway disease (maximum dose reported, 20 mg/d). Medications at presentation included methotrexate, HCQ (300 mg bid), prednisone (10 mg/d), glyburide, and enalapril. She had been taking HCQ for 5 years. She had a 50-pack-year smoking history, discontinued 22 years ago, and denied alcohol and nonprescription drug use.