This patient is a 47-year-old female with a history of end-stage liver disease secondary to hepatitis C virus (HCV) complicated by hepatic encephalopathy, obstructive sleep apnea, asthma, and severe peripheral neuropathy who presents to the hospital with complaints of shortness of breath and cough. The patient was recently discharged from an outside hospital 2 days prior to this admission where she was treated for pneumonia and an asthma exacerbation but her symptoms have not improved. She complains of shortness of breath at rest and severely decreased exercise tolerance with dyspnea while walking across the room. Her cough is persistent and non-productive. Review of systems is also positive for fevers at the outside hospital and worsening peripheral neuropathy which has not responded to treatment with gabapentin. Social history is positive for 20 pack-year smoking history (quit 10 years ago), and heavy alcohol use in the past.