A 50-year-old woman was seen in the office for recurrent episodes of cough and right-sided chest pain. She had visited the ED three times in the past 15 months for the same complaint. Each time, the pain started gradually affecting the right lateral chest wall. It was pleuritic and was associated with cough and mild shortness of breath. During these episodes, she reported low-grade fever but denied any night sweats, chills, sputum production, wheezing, or hemoptysis. She was treated with antibiotics and systemic steroids with resolution of her symptoms. The patient was an active smoker with a more than 35-pack year history. She had no known medical condition and was not taking any medication routinely at home. She had no family history of alpha-1 antitrypsin deficiency or Marfan syndrome.
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