CASE PRESENTATION: A 53-year old male with COPD and recurrent pneumonia presented with headache, productive cough, dyspnea and fever. He had failed outpatient clarithromycin for right upper lobe pneumonia 2 weeks previously. On arrival vitals were stable. Exam showed diminished breath sounds on the right. Neuro exam was normal. CBC showed neutrophilia. Other labs were normal. CXR showed a new right pulmonary nodule while CT revealed a right lower lobe mass with central necrosis worrisome for malignancy. Brain MRI showed multiple, small, ring-enhancing supratentorial lesions with surrounding edema. Otherwise metastatic workup was negative. CT-guided core lung biopsy showed chronic inflammation and focal abscess. Tissue cultures were positive for alpha-hemolytic strep, but negative for TB or fungus. Blood cultures were negative. Differential included Streptococcus and Nocardia. Due to penicillin allergy, he was prescribed six weeks of outpatient IV meropenam monotherapy. Patient returned in two weeks with complaints of sudden onset confusion and complex partial upper extremity seizures. Physical exam including vitals and neuro exam was normal as was CBC and BMP. Repeat MRI revealed ring-enhancing lesions, increasing in size. Antibodies for cysticercosis, toxoplasmosis, Cryptococcus and HIV were negative. CNS lesions were biopsied. Histopathology confirmed an abscess with surrounding reactive glial tissue. Tissue and blood cultures were now positive for SA. Echocardiogram was negative for vegetations. Immunoglobulin levels were normal. He underwent desensitization and was treated with IV ceftriaxone and oral metronidazole for 6 weeks.