CASE PRESENTATION: A 58 year old Vietnamese gentleman admitted with altered mental status, was found to have septic shock with respiratory failure requiring intubation and intensive care monitoring. Examination was significant for tachycardia and soft tissue swelling on the left anterior shin alone. Initial laboratory studies showed leukocytosis, lactic acidosis and elevated liver enzymes. CT head was unrevealing while chest x-ray showed left midlung airspace disease with bilateral pleural effusions. CSF analysis revealed leukocytosis and elevated protein levels. Patient was started on broad spectrum antibiotics and antiviral medications. Further work up with a CT chest (fig.1) revealed innumerable nodules with a right pleural effusion consistent with metastatic disease. CT abdomen (fig.2) demonstrated multiple nodules in the liver and an exophytic mass in the right kidney indicative of abscesses. Further investigation with MRI brain showed multiple cerebral abscesses while retinal exam was consistent with left sided chorioretinits. At this point, infective endocarditis was considered as a possible source of infection but trans-esophageal echocardiography did not show vegetations. Subsequently, blood cultures grew klebsiella pneumoniae and cultures from incision and drainage of the left anterior shin mass was also positive for klebsiella pneumoniae. He underwent drainage of the liver abscess and right sided empyema and completed a total of 8 weeks of therapy with piperacillin/ tazobactam for metastatic klebsiella infection. Following a prolonged hospital course that included tracheostomy for a short time, patient was discharged to a skilled nursing facility. Six months after initial presentation, the patient is able to live independently at home.