A 56-year-old man presented to the pulmonary clinic for evaluation of recurrent pneumonia. He was well until 3 years before this clinic visit, when productive cough for > 2 weeks developed, followed by chills, fever of 39.4°C, and a left lower lobe infiltrate on chest radiography. Antibiotic treatment resulted in complete resolution of symptoms and radiographic findings. One year later, he presented with similar symptoms and a right lower lobe infiltrate. He was admitted to the hospital, sputum cultures were unrevealing, and he recovered after a course of broad-spectrum antibiotics. Four months before presenting to clinic, he choked during a meal and had a persistent productive cough that failed to respond to two separate courses of oral antibiotics. Fever and chills developed, and he was hospitalized for pneumonia. A chest CT scan showed alveolar infiltrates in bilateral lower lobes. His fever resolved with antibiotic treatment, but the productive cough continued. His medical history was unremarkable, and he was a lifelong nonsmoker and took no medications or illicit drugs. He specifically denied consuming mineral oil or using oily nose drops. Review of systems revealed an unintentional 20-lb weight loss over the past 2 years accompanied by frequent loose bowel movements, morning shoulder stiffness, occasional insomnia, and palpitations. He also described a presyncopal episode that occurred following the first pneumonia episode. Emergency department evaluation at that time revealed sinus tachycardia with 2 s of wide-complex tachycardia. Myocardial infarction was excluded, and the echocardiogram and stress and tilt table testing results were unremarkable. He denied loss of consciousness.