Letters to the Editor 87 pericardial effusion. Serologic testing and sputum cultures confirmed coccidioidomycosis. Pericardiocentesis revealed bloody fluid with a red cell count of 1.1 Â 10 12 /L, a white cell count of 9.6 Â 10 9 /L, and a differential of 79% monocytes, 19% neutrophils, and 2% eosinophils. The protein was 6 g/dL, and LDH was 1337 U/L (serum LDH, 248 U/L). Fungal cultures from the fluid were negative. She was treated with intravenous amphotericin B with resolution of disease activity over a 12-month period, and was subsequently placed on continuous treatment with fluconazole 400 mg po, daily (verbal communication, Crum NF). Surgical intervention was not required and there has not been a relapse over a 4-year follow-up period. 2 This is the 18th case of CP in the medical literature. The presentation can be acute, progressing rapidly to effusive-constrictive physiology or the presentation can be that of a chronic constrictive process. The current patient presented with chest pain and dyspnea, a symptom complex similar to previously reported patients with CP. What has not been detailed previously is a bloody pericardial effusion and female sex (presumably prepubertal). The favorable outcome was also expected as the patient did not have disseminated disease nor did she develop pericardial constriction in need of surgical intervention.Conflict of interest: No conflict of interest to declare.