The patient underwent fiber-optic bronchoscopy, which initially was visually unremarkable, with clear mucoid secretions. Upon careful inspection, flecks of black material, which were easily suctioned, were seen diffusely in second-generation bronchi (Fig 3). BAL fluid obtained from the anterior segment of the right upper lobe was initially clear on return, but on subsequent aliquots showed a progressively more “silty” appearance (Fig 4). Routine gram stain, acid-fast bacillus smear, and cultures for bacterial, fungal, and mycobacterial cultures were negative. Washings and brushings for Pneumocystis jiroveci were negative.