This is a 39 year old gentleman of Spanish origin who speaks minimal English and is in a same gender relationship. He is a Type I diabetic for 11 years with poor compliance to insulin, admitted with plantar abscess and has had amputation to 4 toes in his left foot. He was seen by respiratory team with increased SOB, raised CRP with mild lymphopenia. Raised ALP and GGT. CT chest shows bilateral upper lobe confluent airspace shadowing. Cardiomegaly and bilateral effusion. ?Atypical pneumonia ?fungal. He was treated with iv taz, septrin and clarithromycin. CTPA: no PE.