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A 76-year-old woman was admitted to our hospital via the emergency room in June 2008 for persistent fever (temperature on admission, 102 F; maximum temperature, 102.8 F). She was ill-appearing without concerns of clinical instability. Her physical examination was normal except for abdominal tenderness with no rebound or guarding, and infection work-up was unrevealing. Her erythrocyte sedimentation rate was 110 mm/h and her c-reactive protein level was 302 mg/L. A chest radiograph was negative, but computed tomography of the abdomen and pelvis showed a 3.8 cm collection of complex fluid within the uterine endometrium (Image A). She remained febrile despite treatment with vancomycin, imipenem, and fluconazole. Examination under anesthesia with dilation and curettage yielded negative pathology and cultures including bacterial, fungal, and acid-fast bacilli. Given the patient’s lack of improvement …