A 47-year-old man was referred to a pulmonary clinic with a 4-year history of dyspnea, productive cough, weight loss, low-grade fevers, night sweats, and occasional hemoptysis. During those 4 years, the patient had undergone multiple serologic, sputum microbiological, and radiographic studies, as well as a bronchoscopy examination; 4 months prior to referral, due to worsening in symptoms, video-assisted thoracoscopic surgery (VATS) for right lung biopsy was performed. Due to the patient's clinical symptoms and abnormal radiographic findings, he had received multiple courses of antibiotics, including 2 months of RIPE therapy (ie, therapy with isoniazid, rifampin, ethambutol, and pyrazinamide) for undocumented tuberculosis, without any significant response. His medical history was positive for COPD, chronic sinusitis, recurrent pneumonias, gastroesophageal reflux disease, hepatitis C, and alcohol abuse. He did not have any history of uveitis, cervical/lumbosacral stiffness, or musculoskeletal pain. His family history was not contributory. His surgical history was remarkable for a VATS procedure for right lung biopsy. His medication list included formoterol, albuterol, pantoprazole, diazepam, and tiotropium. He smoked two packs of cigarettes a day for 30 years. The patient was from rural Mississippi, and he reported no history of travel outside of this area. He was a farmer but had been unable to work during the last 2 years due to his poor health status.