A 26-year-old man with a history of intermittent fever of unknown etiology for the past 1.5 years presented to our institution with a 2-day history of fever, night sweats, and myalgias. His medical history was unremarkable except for a laparotomy at the age of 6 years following an accidental gunshot wound to the abdomen. He admitted having a previous blood transfusion and recreational use of cocaine and marijuana. Physical examination revealed a depressed affect and multiple skin tattoos, but findings were otherwise negative. CBC count demonstrated a mild leucocytosis (13.6 ×109/L; normal range, 3.4 to 10 × 109/L) and associated lymphocytosis (6.2 × 109/L; normal range, 0.9 to 2.9 × 109/L). Results of extensive laboratory testing (infection, immunology, and biochemistry) were otherwise unrevealing. The appearance of an abnormality on the chest radiograph (Fig 1
) led to a CT study (Fig 2
) and a possible biopsy because of concerns about underlying malignancy. The CT findings prompted another diagnostic study (Fig 3
), and so the biopsy was canceled.