A 40-year-old woman presented on May 10, 2017 with a 6-d history of fever (up to 38.0 °C), non-productive cough, and exertional dyspnea. The patient received empiric amoxycillin (1.5 g/d) at a community clinic 3 d ago, but symptoms persisted. The patient denied hemoptysis, chest pain, and weight loss. The patient was a nonsmoker. She had no family history of hematologic or lung malignancies. Physical examination at admission revealed a body temperature of 39.0 °C, heart rate of 103 beats/min, blood pressure of 120/70 mmHg, and respiratory rate of 25 breaths/min. Wheezes and dry rales were not heard in bilateral lungs on auscultation. No other remarkable abnormalities were found. Laboratory test revealed hemoglobin 115 g/L, red blood cell count 3.98 × 1012/L, and increased leucocyte count (20100/mm3) with 90% neutrophils, 4% lymphocytes, and 1% eosinophils. No atypical lymphocytes were present in the peripheral blood. Laboratory investigations showed elevated C-reactive protein (230.1 mg/mL; normal reference range: < 10.0 mg/mL), procalcitonin (0.88 ng/mL; normal: < 0.10 ng/mL), and erythrocyte sedimentation rate (10 mm/h; normal: < 20 mm/h). Biochemical studies showed hypoalbuminemia (33.2 g/L; normal: 40.0-55.0 g/L), elevated alanine aminotransferase (65 U/L; normal: 7-40 U/L), aspartate transaminase (55 U/L; normal: 13-35 U/L), alkaline phosphatase (129 U/L; normal: 35-100 U/L), and lactate dehydrogenase (LDH) (549 U/L; normal: 114-240 U/L). Arterial blood gas analysis revealed PaO2 at 60 mmHg (normal: 80-100 mmHg) and SaO2 at 90% when breathing ambient air. Tumor biomarkers (e.g., CEA125, CA153, and CA199) were negative. Plasma virus tests for Epstein-Barr virus, cytomegalovirus, and respiratory syncytial virus were negative. Contrast-enhanced computed tomography of the chest demonstrated multiple solid nodules throughout both lungs with the largest measuring 15 mm in diameter, with poor defined boundaries in the right upper lung. No mediastinal lymphadenopathy was demonstrated. A blood culture was ordered.