William D. Zolin Jr, MD, Assistant Resident in Medicine, Department of Medicine, The Jewish Hospital of St Louis: A 61-year-old diabetic woman complained of daily chills and a nonproductive cough for one month. Her symptoms had worsened over the week prior to admission with development of anorexia, dyspnea, and dysuria. She always slept on two to three pillows, but denied a history of edema, chest pain, hypothyroidism, or renal disease. Her diabetes mellitus was controlled with 50 units of isophane insulin suspension (NPH Insulin) daily. A history of untreated hypertension and positive results of a tuberculin skin test also were obtained. The patient's brother, with whom she had lived until the age of 30, had been treated for active pulmonary tuberculosis as a youth. The patient had been employed as a domestic at a physician's residence up to the day of admission. She denied usage of cigarettes and alcohol, and