To the editor: We present a 13-year-old boy with mild persistent asthma and obstructive sleep apnea who initially presented with fever, dyspnea, cough, night sweats and myalgia for 4 days. He reported having an intermittent “hacking cough” for years. Physical examination was significant for diffuse crackles in the right lung base, decreased breath sounds and mild digital clubbing. Initial chest x-ray (CXR) revealed right middle lobe (RML) and right lower lobe (RLL) opacities with right pleural effusion interpreted and treated as community acquired pneumonia. He was followed as an outpatient by his pediatrician and referred to our pediatric pulmonology clinic months later for persistent RLL atelectasis and chronic cough. He was well appearing with similar physical examination findings as described earlier. Laboratory tests including sweat chloride, cystic fibrosis genetic panel, immunoglobulin levels, complement, pneumococcal and tetanus titers were normal.