A 64-year-old male was brought to the hospital for evaluation of weight loss, inability to eat, and coughing with copious oral secretions. He had a history of squamous cell carcinoma of the right oropharynx, status post-chemotherapy and radiation more than 11years ago. He lost follow-up with his oncologist after that. He was hypotensive at presentation and responded to intravenous fluid resuscitation. He was found to be having bilateral, predominantly lower lobe multifocal airspace disease on initial chest X-ray suggestive of aspiration pneumonia and started on antibiotic therapy.
