CASE PRESENTATION: A 52-year-old woman presented to the clinic with progressively worsening shortness of breath associated with intermittent pleuritic left lower back pain for the past 6 months. The patient denied any cough, hemoptysis, fever, chills, or weight loss. She had a history of smoking cigarettes for more than 10 years but quit almost 20 years ago. An outpatient chest radiograph was obtained, and it suggested consolidation of the left lower lobe. The patient was treated empirically with amoxicillin-clavulanate for 2 weeks without improvement.