A 64 year old Vietnamese male with no past medical history presented for evaluation of fevers which started in April 2020. The fevers occurred at least once daily and were associated with sweating and weight loss. Over several weeks he unintentionally lost 4 kg. After a week of fevers the patient sought care. He was a smoker but otherwise healthy and on no medications. He worked as a shrimper but had not worked since November 2019 when the season closed. Physical examination was unrevealing. Serologic testing demonstrated a mild transaminitis, elevated erythrocyte sedimentation rate, and negative viral hepatitis screen. Initial imaging with right upper quadrant ultrasonography demonstrated multiple hypoechoic lesions (Figure 1). Computer tomography (CT) of the abdomen demonstrated a 6 cm multi-cystic partially enhancing mass within the right hepatic lobe (Figure 2). He was hospitalized and a drain was percutaneously placed. Purulent debris drained which grew methicillin sensitive Staphylococcus aureus (MSSA). The patient was tested for a variety of organisms and tested negative (ie, no TB, malaria, etc.) Tissue samples obtained from the hepatic lesion also demonstrated fibro-inflammatory lesions with focally increased IgG4 positive plasma cells (Figure 3). He started intravenous antibiotics and a serum IgG4 level was elevated at 322 mg/dL (normal range: 4-86 mg/dL). He was treated with 2 months of intravenous antibiotics and monitored clinically but not placed on immunosuppressive therapy. In accordance with the comprehensive diagnostic criteria of IgG4 related disease, patient fulfilled all 3 criteria to include clinical, hematological, and histopathological. Unfortunately, patient was lost to follow up during the covid pandemic and did not follow up for repeat evaluation and proper treatment.