A 25-year-old man presented to the emergency department complaining of shortness of breath, cough, and malaise, which had progressed over the preceding several weeks. He had a 7-year history of daily methamphetamine use. He had presented to the emergency department 3 times in the previous month complaining of similar symptoms and had been discharged with treatment for an upper respiratory infection; there was no evidence of hemodynamic instability. At this presentation, however, his blood pressure was 95/60 mm Hg, his heart rate was 114 beats/min, and his oxygen saturation was 98% on room air.