An 81-year-old woman being treated for chronic urticaria consulted our outpatient clinic with a twoweek history of productive cough and fever. Six months prior to the consultation, she consulted a dermatologist and was treated with an antihistamine-1-receptor blocker against urticaria. Since her itching continued, diaminodiphenyl sulfone (DDS), 50 mg daily, was added. The chronic urticaria then gradually improved, and the DDS was continued. Two weeks prior to the consultation, she developed malaise and cough with whitish sputum. On thoracic computed tomography (CT), a bilateral upper lobe and subpleural lesion-dominant, multiple, nonsegmental, consolidative shadow was observed (Figure 1). The possibility of community-acquired pneumonia was highly suspected, and a combination of clarithromycin and ceftriaxone for one week was given at a family practice office. However, her symptoms and the infiltrative shadow on chest X-ray gradually worsened, and she consulted our outpatient clinic. On physical examination, auscultation of her chest showed early inspiratory crackles. Blood laboratory examination showed: white blood cell count 9150/µL, eosinophils 5.8% (531/µL), red blood cell count 2,800,000/µL, hemoglobin 8.8 g/dL, hematocrit 28.1%, platelet count 249,000/µL, total protein 6.8 g/dL, albumin 4.0 g/dL, AST 20 IU/mL, ALT 9 IU/mL, LDH 201 U/mL (normal range: 106-211 U/mL), Fe 76 µg/mL, ferritin 402 mg/ mL, total iron-binding capacity 110 µg/mL, Na 145
