A 64-year-old man was admitted for evaluation of progressive dyspnea and cough productive of copious amounts of clear sputum. About 3 months prior to presentation he had developed dyspnea and cough while traveling in Texas and Arizona. He was hospitalized and treated with antibiotics for presumed left lower lobe pneumonia. A diagnosis of left lower extremity DVT was also made, for which anticoagulation with warfarin was initiated. After discharge, he felt well for some days but subsequently noted recurrence of dyspnea and cough, along with fevers, prompting a second hospital admission. Chest imaging with CT scan at that time showed extensive bilateral ground-glass opacities. The patient required noninvasive respiratory support and was started on broad-spectrum antibiotics. Extensive infectious work-up was unrevealing. He was discharged feeling slightly improved on supplemental oxygen and an empirical antibiotic course. His medical history was otherwise notable for coronary artery disease, hypertension, hyperlipidemia, chronic compensated systolic heart failure with an ejection fraction of 39%, COPD (FEV1, 74%), type 2 diabetes mellitus, and chronic kidney disease.