This 49 y/o hispanic male presented with chest pain, shortness of breath, fever of 101.2°F and mild hypoxemia. The patient had been a farm laborer in California for many years. Physical examination was unremarkable. Chest x-ray was normal. WBC - 10,500, urinalysis - normal, EKG - normal, PPD - negative, blood cultures - negative. The patient developed progressive shortness of breath and hypoxemia. Intermittent fever to 101.5°F was recorded. Physical exam remained unchanged and additional workup was negative. On the fouth hospital day 24 hour gallium scan images were obtained. They are shown above. A chest CT was then performed. Selected images are shown above. The gallium scan demonstrares uptake in the pericardium and the CT scan shows thickening of the pericardium. The negative workup for bacteria, the negative TB test and the history of farm labor in California led to the specific diagnosis of coccidioidal pericarditis which was confirmed and treated successfully with full recovery.
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