A 29-year-old Hispanic female patient with a history of rheumatic mitral stenosis, pulmonary embolism, and right upper extremity deep vein thrombosis presented to the emergency department owing to respiratory failure and bilateral large pleural effusions requiring intubation and thoracentesis. She had been previously admitted for shortness of breath and pleuritic chest pain attributed to heart failure exacerbation and transudative pleural effusions requiring thoracenteses. She resided in a trailer home and worked in a lettuce processing plant.