A 45-year-old man presented with progressive dyspnea for 2 weeks, left pleuritic chest pain for 1 week, and a bilateral ankle rash for the past 10 days. He had hepatitis C, for which he had received no treatment, and a history of polysubstance abuse, but he had not consumed alcohol for 7 years or IV drugs for 20 years. He was a current cigarette smoker (15 pack-year history of smoking). Eighteen months ago, he was found to have stage 4 embryonal left testicular cancer, metastatic to the lungs, and the retroperitoneal, axillary, and inguinal lymph nodes. He underwent a left orchiectomy and received six cycles of chemotherapy with bleomycin, etoposide, and cisplatin. His serum α-fetoprotein level was 77 μg/L and fell to 5 μg/L after chemotherapy. A repeat chest CT scan showed nearly complete resolution of pulmonary metastases with multiple, small, subcentimeter nodules bilaterally, and one nodule in the left upper lobe measuring 1.2 × 0.9 cm. There had been no follow-up for the preceding 12 months.