CASE PRESENTATION: A previously healthy 53-year-old woman with 4 months of dyspnea and subjective wheezing presented to pulmonary clinic for a second opinion. Her medical history included hypertension, obesity, and OSA. She had been hospitalized 3 months prior at an outside hospital for evaluation of these symptoms. She had never smoked. She was a retired teacher and previously served as a pet nanny to dogs and cats. She denied antecedent respiratory infection or environmental exposure before the onset of her symptoms. Current medications included budesonide-formoterol, tiotropium, loratadine, and montelukast. She did not experience significant change in symptoms with bronchodilators or corticosteroid treatment.