Hemogram results were WBC count, 9,200 cells/μL with 30% band forms; hemoglobin, 7.0 g/dL; and platelet count, 26,000/μL. Blood chemistry levels were sodium, 124 mmol/L; potassium, 5.5 mmol/L; chloride, 90 mmol/L; bicarbonate, 16 mmol/L; urea nitrogen, 66 mg/dL; creatinine, 3.6 mg/dL; glucose, 384 mg/dL; albumin, 1.7 g/dL; total bilirubin, 30.4 mg/dL (conjugated 18.6 mg/dL); alanine aminotransferase, 65 units/L; aspartate aminotransferase, 72 units/L; and alkaline phosphatase, 144 mU/mL. Coagulation study results revealed international normalized ratio 3.1 and a partial thromboplastin time of 41.7 s. Tacrolimus level was 5.7 ng/mL (normal, 0.5-20 ng/mL). Blood cultures were drawn. Chest radiograph on admission (Fig 1) showed a right-sided pleural effusion and pleural catheter.