A 62-year-old woman with a history of seropositive rheumatoid arthritis presented with a history of exertional dyspnea, a cough productive of greenish sputum, fevers, chills, and malaise for several weeks. She had experienced no weight loss, night sweats, or hemoptysis. She lived in Brooklyn, NY, had not traveled recently, and denied any contacts with sick patients. There was no history of occupational or environmental exposures, but she admitted to a remote history of smoking. She had received a diagnosis of rheumatoid arthritis 10 years prior to presentation. Her disease was nonerosive, manifested as minimal joint symptoms in her hands, and had been well controlled with prednisone, 5 mg bid, and leflunomide, 20 mg/d. A month earlier, she had been seen at another hospital for similar symptoms, at which time a CT scan of the chest revealed multiple cavitating lung nodules. A CT scan-guided biopsy specimen showed nonspecific necrotic material, and the procedure had resulted in a pneumothorax, which was successfully drained.