A 24 year-old woman with a known history of sickle cell disease presented to an outside hospital (OSH) with a two-day history of progressive shortness of breath, chest pain, and fever. She also complained of productive cough with green sputum. Chest X ray showed a left lower lobe infiltrate. She was started on antibiotics (ceftriaxone and azithromycin). Her Hb and platelet count started to fall, so she was transferred to your institution for higher level of care. She has had multiple past admissions for pain crises and acute chest syndrome. She also has a history of osteonecrosis and had a cholecystectomy in the past. Her family history is positive for sickle cell disease. She is a non-smoker and drinks socially. She is currently on disability. Medications at time of initial presentation to OSH included folic acid and hydroxyurea. She has no known allergies.