Case Presentation: A 38 year-old-male with cirrhosis from hepatitis B and C complicated by recurrent ascites, previous spontaneous bacterial peritonitis (SBP), and recurrent hepatic hydrothorax requiring transjugular intrahepatic portosystemic shunt presented with two days of increasing dyspnea at rest. He had recently been nonadherent with SBP prophylaxis and diuretics. Laboratory findings revealed leukocytosis of 17,500k/uL, [...]