A 62-year-old man was transferred to our hospital for evaluation and management of hemoptysis and dyspnea that had started 5 days earlier. Review of systems revealed subjective fevers and chills, ankle swelling, and a rash on his feet. His home medications included lisinopril, hydralazine, metoprolol, and levothyroxine. Blood pressure was 142/80 mm Hg, heart rate 87 beats per minute, respiratory rate of 14 per minute, and he was afebrile. Physical examination findings included harsh breath sounds with diffuse crackles, and a papular rash over his ankles.