Snapshot A 52-year-old alcoholic and know homeless man presents with fever, cough, and fatigue. He has purulent sputum and foul smelling breath. An CXR shows a lesion in the upper left lobe of the lung. Presentation Symptoms fever purulent sputum sepsis fatigue four smelling breath Evaluation CXR: look for air fluid levels CT Bronchoscopy with biopsy/cx Treatment Medical antibiotics Surgery indicated for cancer patients Refractory to Abx