CASE PRESENTATION: A 52-year-old man presented with repeated cough and worsening exertional dyspnea for 5 years. Long-term oral prednisone had been administered with little effect. He denied chest pain, hemoptysis, or nighttime paroxysmal dyspnea. His medical history included chronic hepatitis B, liver cirrhosis, splenomegaly, diabetes insipidus, and hypertension. He denied consuming alcohol or illicit drugs. He was a never smoker. His family history was noncontributory.