A 21-year-old man presented with fever, altered mental status, and hemoptysis. Four days earlier, he was seen at an emergency department with complaints of sore throat, fever, pain, and swelling in the neck. The results of an Epstein-Barr virus monospot test was negative, and the patient was discharged from the hospital with symptomatic therapy for treatment of a viral syndrome. He returned to the same emergency department 3 days later with a fever to 105°F, cough productive of bloody sputum, and confusion. He was noted to be delirious and jaundiced. Blood cultures were drawn, and the patient received therapy with vancomycin and piperacillin/tazobactam. He was then transferred to our hospital for further management. On arrival, the patient was in respiratory distress. He was intubated for acute hypoxemic respiratory failure and delirium.