A 53-year-old woman was admitted to the hospital with a complaint of progressive shortness of breath. Two years prior, she had been treated for pneumonia but still complained of a chronic nonproductive cough. She had been followed up for > 2 years by serial CT scans for a pneumonitis, which was presumed by her primary care physician and rheumatologist to be secondary to her history of systemic lupus erythematosus. Her remaining medical history was significant for COPD, congestive heart failure, chronic pain, venothromboembolic disease, anxiety, depression, and chronic nausea. She had an indwelling central venous catheter for promethazine administration as a treatment for her chronic nausea and vomiting. She denied illicit drug use, but was receiving therapy with oral hydromorphone for chronic pain. Her other medications included prednisone, esomperazole, alprazolam, warfarin, and escitalopram.