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History A 55 year-old non-smoker Caucasian man with history of hypertension presented to the pulmonary clinic with six months of progressive shortness of breath on exertion and productive cough. The patient endorsed occasional exacerbations of his symptoms characterized by flu-like symptoms, subjective fever and worsening productive cough of purulent sputum. He noted progression of his dyspnea with no return to his previous baseline following these exacerbations.