In 2016 a 37-year-old man with X-linked CGD and lupus-like skin lesions presented with red discoloration of the skin around the xiphoid process, fever and heavy pain in the abdomen that had begun 3 days earlier. He was on vacation in Suriname and had visited a creek recreational area a few days earlier. His initial diagnosis was necrotizing fasciitis. He appeared to be suffering from sepsis, with a blood pressure of 130/90 mmHg, a heartbeat of 120 b.p.m., a respiratory rate of 20 breaths min-1, a peripheral oxygen saturation of 96 % and a temperature of 39  C. His abdomen was tender without resistance. The only plasma abnormalities were creatinine 117 mumol l-1 (60-110 mumol l-1), sodium 130 mmol l-1 (132-148 mmol l-1), C-reactive protein 22.1 mg dl-1 (0.0-0.5 mg dl-1), leukocytes 20.0x109 l-1 (4.5-11.0x109 l-1) and thrombocytes 147x109 l-1 (150-400x109 l-1). He started with amikacin, clindamycin and flucloxacillin. A necrotomy was performed the next day. A computed tomography (CT) scan of the thorax and abdomen revealed pre-broncheal nodular opacities and hepatosplenomegaly and no characteristic findings for necrotizing fasciitis. Within 48 h the patient developed respiratory failure and haemodynamic instability, for which he was transferred to the intensive care unit (ICU) for mechanical ventilation and intravenous vasopressors. He had progressive renal failure and elevated liver enzymes and developed leukocytopenia and trombocytopenia; creatinine 372 mumol l-1, aspartate aminotransferase 100 U l-1, alanine aminotransferase 102 U l-1, lactate dehydrogenase 352 U l-1, leukocytes 3.8x109 l-1, thrombocytes 79x109/L. A repeat CT scan of the thorax and abdomen showed progressive ground glass opacities from the lower lobe of the lungs, pleural effusion, ascites and hepatosplenomegaly with liver abscesses. The wound, blood and faecal cultures turned positive for  C. violaceum , with sensitivity to gentamicin, doxycyclin, ciprofloxacin and trimethoprim/sulfamethoxazole (Fig. 1). The patient's antibiotics were switched to ciprofloxacin and meropenem because of progressive renal impairment. Voriconazole was empirically added to the regime. Ancillary testing for Aspergillus could not be performed. No fungi were later cultured from the different samples. Prednisone was added due to secondary adrenal insufficiency in septic state. Five days after presentation the patient started with continuous veno-venous haemofiltration (CVVH) due to progressive renal failure with oliguria and generalized edema. This was discontinued 5 days later after renal function improvement. The mechanical ventilation could also be discontinued afterwards. He was dismissed from the ICU after a total of 14 days. Further care and rehabilitation continued in strict isolation due to a multi-resistant  Acinetobacter  baumanni in inventory sputum cultures. After a total of 21 days the patient could be discharged from the hospital and he returned to the Netherlands.