[Status febrilis and jaundice]

A 49 year old patient was admitted with fever and jaundice. Laboratory evaluation showed leukocytosis, elevated values for C-reactive protein, transaminases, bilirubin and alkaline phosphatase. Ultrasound and subsequent CT-scan revealed multiple liver lesions and a liquid mass in the bursa omentalis. A CT-guided catheter-drainage was performed and streptococcus milleri isolated from the abscess and one blood culture. After empiric broad spectrum treatment with Piperacillin/Tazobactam (Tazobac) and Netilmicin (Netromycin), Ceftriaxon (Rocephin) was given for a total treatment time of 10 days. Further evaluation revealed a perforated peptic ulcer as possible etiology for the described localized infectious complication.