A 42-year-old Hispanic woman was admitted to the hospital for progressive exertional dyspnea and nonproductive cough for 6 months. She reported worsening symptoms over 2 weeks that had not responded to outpatient treatment of community-acquired pneumonia. She denied fevers, chest pain, hemoptysis, and weight loss. She was an active smoker, with a 9-pack-year history of tobacco use. She was originally from Puerto Rico but had lived in the United States for the past 17 years. She denied any recent travel or exposure to TB. Her medical history included resolved polyarthritis of her hand joints a year prior to presentation. Surgical and family histories were otherwise unremarkable.