Ms PM is a 28-year-old female, originally from Eastern Cape Province in South Africa (SA). She was first admitted in July 2017 for severe respiratory distress at a district hospital in Gauteng Province, with a working diagnosis of multi-lobar pneumonia. Further examination revealed significant wasting, pallor and oral candidiasis. Her oxygen saturation was 82% on room air, which improved to 100% on supplemental oxygen. She was hypotensive (blood pressure 89/65 mmHg), and tachycardic (120 beats per minute) due to sepsis. 
 Her chest X-ray showed diffuse, multiple thin-walled cysts (one with air-fluid level) of varying sizes in both lung fields; as well as the peri-cardiac region (Fig. 1). Due to the patient's rural background, hydatid lung disease was now the working diagnosis. A computed tomography (CT) scan of the chest could not be performed at this district hospital as the scan machine was not operational. 
 Blood results showed acute kidney injury (resolved with crystalloid fluids), a raised c-reactive protein (CRP) of 143 mmol/L, and a normocytic anaemia attributed to her HIV infection. The hydatid serology and the serum cryptococcal latex antigen test (sCLAT) performed was negative. Sputum investigations were negative for tuberculosis, yeast and/or fungal species. Bronchoscopy equipment was not available at this hospital, and no further biological samples could be collected.