She was receiving no medications, and did not drink alcohol, smoke cigarettes, or use recreational drugs. Coccidioidomycosis was previously diagnosed in a family member. The patient had noted occasional abdominal bloating, night sweats, and chills without fever, and an 8-lb unintentional weight loss over the previous 3 months. She had no known tuberculosis exposures, and a recent tuberculin skin test result was negative. She denied rash, joint pain, nausea, hemoptysis, orthopnea, hematochezia, dizziness, visual changes, dyspareunia, or dyschezia. She has a history of dysmenorrhea and was on her menses at the time of hospital admission.