At the time of presentation, the patient could only walk 15 m on oxygen; 5 years ago she could walk for several hours without difficulty. Additional symptoms included orthopnea, which required her to sleep with two to three pillows or in a recliner, and which was better in either left or right decubitus. She denied fevers, chills, night sweats, weight change, lower-extremity edema, paroxysmal nocturnal dyspnea, dysphagia, cough, hemoptysis, or any other symptoms. Home medications included atenolol, spironolactone, and warfarin. She had no smoking history but she did have 30 years of exposure to secondhand smoke. She had no pets at home, and prior to this trip she had never previously traveled outside Iran.