A 71-year-old man complained of 3 days of fever to 102°F, dyspnea, sore throat, hoarseness, and a cough productive of yellow sputum. He had no recent travel or animal exposure, but he had lately been around children who were coughing. He did not smoke or drink alcohol in excess. He had type 2 diabetes for many years, which was well controlled with oral therapy. For about 12 years he had a chronic nonproductive cough with occasional episodes of wheezing. He had no history of sinus disease. At baseline, his oxygen saturation was 97%. A chest radiograph performed 18 months earlier was normal except for calcified hilar and subcarinal lymph nodes. His pulmonary medications, prescribed for presumed cough-variant asthma, included inhaled budesonide/formoterol, inhaled albuterol/ipratropium, montelukast, and theophylline. He had just completed a short course of oral prednisone that had not helped a recent worsening of his chronic cough.