An unexpected expectoration

An 83-year-old woman with a history of antiglomerular basement membrane (anti-GBM) disease and congestive heart failure presented to the emergency department in late July 2017 with hemoptysis. She had initially noted dyspnea on exertion and cough productive of blood-streaked sputum 5 days before presentation; on the day of presentation, the cough became productive of small amounts of bright red blood. She reported fatigue but no fevers, chills, or night sweats, and her weight had remained stable.