A periparturient Jersey cow with unilateral inhalation pneumonia of 4 days duration. The cow inhaled rumen contents after becoming cast due to hypocalcemia 12 hours after calving. There is generalized, severe muscle weakness, pyrexia, tachycardia, and tachypnea with spontaneous cough and increased respiratory noise. The patient also has bilateral purulent, fetid nasal discharge and poor rumen motility likely secondary to anorexia. When standing, the back is arched, likely due to pain. Sclera are reddened, consistent with endotoxemia secondary to severe aspiration pneumonia caused by mixed aerobic and anaerobic infection.