A 47-year-old man with no known past medical history presented to the emergency room with two weeks of progressive lower extremity swelling and dyspnea. He reported associated orthopnea and denied chest pain or palpitations. He had no known personal or family history of illness. He denied history of alcohol, tobacco or drug use. He immigrated to the United States from rural Mexico 9 years prior to presentation and currently works as a cook.
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