CASE PRESENTATION: A 27 year old male with history of mixed connective tissue disorder, systemic lupus erythematosus, Raynaud’s phenomenon, and splenectomy at age 13 presented with pneumococcal sepsis despite adequate vaccination, acute renal failure, and acute respiratory failure status post- intubation. Vitals were a temperature of 104.4 deg F, heart rate 160 and blood pressure of 80/40 mmHg. Workup revealed lactic acidosis, elevated liver transaminases, acute kidney injury, elevated troponin, and elevated creatine kinase. Abdominal CT showed moderate ascites without acute intra-abdominal pathology. Because physical exam demonstrated tenderness, rigidity, and guarding with increasing lactate level, the patient was taken for emergent exploratory laparotomy which only re-demonstrated mild ascites without viscous perforation. His leukocytosis (65,700 cells/mm3) and thrombocytopenia worsened so the patient was started on high dose ceftriaxone and 300 mg daily hydrocortisone for lupus vasculitis. After two days, the patient’s overall condition and abdominal exam improved but his leukocytosis worsened. CT abdomen demonstrated 10-15 liver hypodensities consistent with abscesses so antibiotics were switched to linezolid and meropenem. The patient continued to improve and was transferred out of the ICU 11 days after admission.