A 68-year-old man with COPD and stage IV bladder cancer started therapy with gemcitabine (days 1 and 8) and carboplatin (day 1) every 3 weeks. After cycle 6, he was admitted to the hospital for neutropenic fever. Hypoxemia required supplemental oxygen therapy at 6 L/min via nasal cannula. Despite therapy with broad-spectrum antibiotics and the recovery of neutrophil counts, fever persisted. The patient complained of shortness of breath, cough with blood streaking, and green sputum.