A 43-year-old man with persistent fever and sudden shortness of breath.

A 43-year-old white man with a 3-week history of nonproductive cough, wheezing, and chest pain was treated with a standard regimen of oral antibiotics in the primary care setting with little clinical improvement of symptoms and then was admitted to the ED of our hospital for acute onset of shortness of breath. He had an otherwise unremarkable medical history, with the exception of chest trauma 3 years prior to admission. He had a smoking history of 18 pack-years and had quit smoking 26 years prior to presentation. Working in a slaughterhouse for 15 years had given him a long occupational exposure to cattle