A 64-year-old woman with underlying hypertension treated with oral perindopril presented with a history of worsening abdominal distension, bilateral leg swelling, and exertional dyspnea over 4 months. In addition, she also complained of intermittent palpitations, weight loss, and anorexia. Her blood pressure was 125/68 mmHg, and she was tachycardic (114 beats per minute) with a low-grade fever of 37.5°C (99.5°F) and good oxygen saturation on room air. Physical examination suggested the presence of third-space fluid loss, evidenced by ascites, right-sided pleural effusion, and bilateral lower limb edema. There was no cardiac murmur or evidence of chest infection on examination.