On examination, the patient had a temperature of 38.0°C, respiratory rate of 24 breaths/min, heart rate of 108 beats/min, and BP of 130/70 mm Hg with an oxygen saturation of 88% while breathing room air. Head, ear, nose, and throat examination was unremarkable. The neck was supple, and no lymphadenopathy was noted. Cardiovascular system examination was normal other than sinus tachycardia. Chest examination revealed a thoracotomy scar on the right side with bilateral middle and lower zone midinspiratory crackles. Extremities revealed finger clubbing but no peripheral edema. No skin lesions were noted. Blood count revealed a hemoglobin level of 14.0 g/dL, WBC count of 12,400/μL with 90% neutrophils, and a platelet count of 350,000/μL. Basic metabolic panel, liver function tests, and coagulation profile were normal. Pathology slides from the previous upper airway biopsy were reviewed (Fig 1). Representative sections of his most recent CT scan are shown in Figure 2.