A 16-YEAR-OLD GIRL was seen for fever, headache, malaise, and right-sided chest wall pain of 1 week's duration. Prior to presentation, she developed a dry cough and nighttime sweating. On admission, her temperature was 38.8°C; pulse, 100 bpm; respirations, 20 breaths per minute; blood pressure, 114/75 mm Hg; and oxygen saturation, 95% breathing room air. She had dullness to percussion and decreased breath sounds over the lower 2/3 of the right posterior lung field. Upright and decubitus chest radiographs showed a free-flowing pleural effusion occupying 3/4 of her right lung field. Further questioning revealed she had emigrated to the United States from Haiti 4 months earlier and had negative findings on purified protein derivative (PPD) testing 3 months earlier. Her white blood cell count was 6800/µL (64% neutrophils, 3% bands, 17% lymphocytes, and 16% monocytes). Values for hematocrit and platelet count were normal; serum total protein, 7.4 g/dL; serum lactate dehydrogenase (LDH), 578 U/L.