A 19-year-old woman with a history of asthma was transferred from a community hospital for cough and progressive dyspnea over the past month. There was no history of fever, chills, night sweats, weight loss, or headache. Her medical history included allergic rhinitis and asthma, which was diagnosed 10 years earlier. Medications included intermittent need for budesonide/formoterol, albuterol, and fexofenadine. Social history included that she attends high school, lives with her parents, and has no previous alcohol or tobacco use. There was a reported history of thyroid cancer in one family member.