In December 1983, a man aged 55 years complained of left arm stiffness, soreness, and paresthesias. On examination, he had decreased blink frequency, poverty of spontaneous movement in general and especially of the left upper extremity, stiff gait, and en bloc turning. His left arm was kept in slight flexion and had increased tone with cogwheel rigidity and decreased rapid alternating movements. A diagnosis of PD was made, but no treatment was started until September 1984, when bromocriptine mesylate therapy was started and the dosage was titrated to 22.5 mg/d with moderate improvement in left arm symptoms. In July 1985, the bromocriptine mesylate dosage was reduced to 15 mg/d and carbidopa and levodopa therapy were started and increased to 3 divided doses of 75 and 300 mg, respectively, with marked symptomatic improvement. Slight deterioration ensued over the next years, and in October 1987, amantadine hydrochloride therapy at a dosage of 200 mg/d was added with minimal symptomatic benefit. In June 1989, after stopping amantadine therapy because of ankle edema, his left-sided PD symptoms increased, and subsequently improved partially when amantadine therapy was restarted. In August 1989, bromocriptine therapy was discontinued and pergolide mesylate therapy at a dosage of 1.5 mg/d was initiated. His parkinsonism progressed, necessitating adjustment of the levodopa dosage. In August 2000, a cough and shortness of breath developed that led to the diagnosis of pleural effusion (Figure 2A). At that time, he also received daily treatment with tolterodine tartrate, 2 mg; lisinopril, 5 mg; spironolactone, 25 mg; furosemide, 40 mg; and aspirin, 81 mg.