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The Pediatric Infectious Disease Journal • Volume 38, Number 10, October 2019 www.pidj.com | 1071 THE CASE A 19-month-old boy was admitted to our department with a 2-week history of fever and moderately elevated inflammatory parameters [C-reactive protein (CRP) of 70 mg/dL], persisting despite empirical treatment with amoxicillin/clavulanate. He was previously healthy, and his vaccinations were up to date. The family had no pets and had not traveled outside Europe. Physical examination revealed right cervical adenopathy (20 × 20 mm) without clinical signs of inflammation. The rest of the physical examination was unremarkable. Laboratory results showed a white blood cell count of 25 × 10/L, hemoglobin of 9.3 g/ dL and platelet count of 553 × 10/L. CRP was 154 mg/L. Cervical ultrasound detected multiple enlarged lymph nodes bilaterally and a large fluid collection on the right side measuring 19.9 × 23 mm, compatible with an abscess. Intravenous (IV) amoxicillin/ clavulanate (100 mg/kg/day) was administered, and the collection was surgically drained. Surgical cultures grew methicillinsusceptible Staphylococcus aureus. Despite antibiotic therapy and surgical drainage, the fever persisted, prompting further investigations. An abdominal ultrasound revealed multiple liver nodules, and magnetic resonance imaging showed multiple T2 hyperintense and T1 hypointense lesions in the liver with restricted diffusion, compatible with abscesses (Fig. 1). Ultrasoundguided biopsy of the liver nodules showed a focal fibroinflammatory process, suggestive of an infectious process. Cultures from the liver biopsy did not grow any organisms. Liver function tests were normal except for a transient moderate elevation of gamma-glutamyl transpeptidase. Bartonella henselae serology, interferon-gamma release assay, serum Aspergillus antigen, and culture and broad-range polymerase chain reaction of the blood were negative. An additional test revealed the underlying diagnosis. For Denouement see P. 1072.