A 41-year-old woman with a 19 pack-year smoking history presented to her physician with a 2-month history of progressively worsening dyspnea. Pulmonary function testing revealed a severe obstructive ventilatory defect and air trapping with an FEV1 of 0.53 L (18% of predicted) and a residual volume of 4.09 L (254% of predicted). CT chest scan showed diffuse bilateral bronchiectasis and air trapping (Fig 1). She initially received a diagnosis of severe asthma and was started on high-dose oral steroids. Two months later she experienced painful ulcers on her tongue and oral mucosa as well as dry eyes, blurred vision, associated conjunctivitis, and a 20-pound weight loss over 2 months. Stevens-Johnson syndrome was suspected; however, punch biopsy from the mandibular labial mucosa revealed herpes simplex virus. She was treated with acyclovir for recalcitrant herpes stomatitis with minimal improvement.