A black man in his early 70s complained of progressive dyspnea on exertion for 15 years. He had occasional cough productive of clear sputum, but no chest pain. He had a 60-pack-year smoking history and previous illicit drug use, including IV injection of heroin and methylphenidate, complicated by tricuspid valve endocarditis nearly 30 years ago. He had no significant travel or occupational history. He had no visual complaints. He did not drink alcohol and had no pets or exposure to birds. He had no known previous TB, and his tuberculin test was negative.