A 69-year-old woman presented to the emergency room with progressive dyspnea over the previous week. She had a history of common bile duct adenocarcinoma and had undergone a curative Whipple operation 4 years earlier. She reported no other symptoms. She denied use of alcohol, tobacco, illicit drugs, and other medications. Physical examination revealed a temperature of 35.8 °C, heart rate of 90 beats per minute, respiratory rate of 24 per minute, and blood pressure of 131/70 mm Hg. Her lungs were clear, heart sounds were normal, and no edema was noted.