Case of the Month - November 2019 Case of the month archive A 59 year old man with HIV infection, COPD, and heart failure developed shortness of breath. He had been hospitalized two weeks earlier for pneumonia and a COPD exacerbation and was treated with ceftriaxone and then cefpodoxime to complete a 7 day course. His shortness of breath persisted after he was discharged, so he was re-hospitalized. He also had a cough with clear sputum but no fever. The patient takes prednisone 20 mg daily, albuterol and budeonide-formoterol inhalers several times a day, trimethoprim-sulfamethoxazole 160-800 three times a week, voriconazole 200 mg daily, and a variety of cardiac medications. Despite broad-spectrum antibiotics, he improved only slightly, and eventually had bronchoscopy with a lung biopsy. GMS stained lung sections are shown in the figures (1000X). What is the organism? GMS stain, 1000X magnification (left and right)