A 34-year-old female presented with several weeks of fever, fatigue, weight loss, abdominal pain and hemoptysis. PE revealed moderate pallor, RUQ pain, mild dyspnea, conjunctival injection and hepatomegaly. The CBC showed anemia, mild leukocytosis, hypoalbuminemia, hypertransaminasemia, presence of nucleated red blood cells. Microsporidium was found in BMA.