A 57-year-old Japanese man with non-insulin-dependent diabetes mellitus presented with 3 weeks of fevers, chills, and a 15-pound weight loss. On examination, he was afebrile (37.5 C) and hypotensive (99/60 mmHg). He was noted to have severe rigors. Physical examination revealed right upper quadrant abdominal pain, and Murphy’s sign was not present. Laboratory tests were significant for leukocytosis (19,800/ul, 91% neutrophils), hyponatremia (122 mmol/l), and hyperglycemia (592 mg/dl). Albumin was low at 1.9 g/dl. Computerized tomography of the abdomen showed a large intrahepatic lesion containing gas (Fig. 1). Given the concern about a pyogenic liver abscess, the patient proceeded to interventional radiology, and percutaneous drainage removed more than 400 ml of purulent material. Klebsiella pneumoniae subsequently grew from both the drainage material and blood cultures. HIV testing returned negative. The patient did well and was discharged home with oral antibiotics and a hepatic drain on hospital day 10. Figure 1 Computerized tomography of the abdomen showing a large intrahepatic lesion containing gas. The prevalence of Klebsiella pneumoniae as a pathogen in hepatic abscesses is rising in Asian countries, particularly in Japan and Taiwan.1 Patients with diabetes, alcoholism, or cancer are at increased risk. In contrast to other pyogenic hepatic abscesses, Klebsiella hepatic abscesses are usually solitary and monomicrobial.2 Early drainage is associated with improved outcomes.3