A 39-year-old male, chronic alcoholic presented to surgical outpatient department (OPD) with the chief complaints of pain in the left upper abdomen along with difficulty breathing for seven days. Pain was insidious in onset, dull aching type with no any relieving factors. Breathing difficulty was associated with productive cough, whitish in color, non-foul smelling and not mixed with blood. Cough was followed by lower chest pain in the left side. Also, there was a history of loose motion for four days, 3-4 times/day not mixed with blood or mucus. There was no history of fever, burning micturition, headache, dizziness, orthopnea or paroxysmal nocturnal dyspnea (PND). On examination, the patient looked ill. Icterus was present. Vitals were within normal limit except for respiratory rate (RR) which was 24 breaths/min. Spo2 was 92% in room air. Chest examination showed decreased air entry on left lung field with dullness appreciated while on percussion. Abdominal examination revealed tenderness on left hypochondriac region with splenomegaly around 3 cm below left subcoastal area along with enlarged liver around 7 cm below right subcoastal margin. Laboratory parameters showed hemoglobin (Hb) 10 gm/dl, Erythrocyte Sedimentation Rate (ESR)- 25 mm/1 st hour, Total Leucocyte Count (TLC)- 35,800/mm3 with neutrophilia (88%), prothrombin time (PT): 30 s with International Normalized Ratio (INR)- 2.07. Renal Function Test (RFT) was normal. HIV, HBSAG, HCV serology were negative. Stool examination along with WIDAL test was normal. Liver Function Test (LFT) showed total bilirubin 3.4 mg/dl, direct bilirubin 2.1 mg/dl, Alanine Amino Transferase (ALT) -15 U/L, Aspartate Amino Transferase (AST)- 40 U/L and Alkaline Phosphatase (ALP)- 216 U/L. Ultrasonography abdomen and pelvis showed enlarged liver and spleen with echogenic fluid noted in peri splenic region with no vascularity and low-level echoes floating within it. Free fluid was noted in the peritoneal cavity along with echogenic free fluid in left pleural space. Chest X ray showed complete white out lung field on left side (Fig. 1). Chest tube drain was inserted on the left chest, which drained around 1500 ml of pus. Contrast enhanced computed tomography (CECT) abdomen showed splenomegaly (14 cm) with non-enhancing hypodense collection of mean HU 14 measuring 6.3 x 3.3 x 5 cm (approx. 54 ml) in the inferior pole of the spleen with peri splenic extension along with irregularity at lower pole suggesting parenchymal origin of the abscess. Liver was enlarged (19 cm), portal vein diameter of 16 mm with left sided pleural effusion with collapse of posterior basal segment of left lung along with mild right sided pleural effusion and minimal pericardial effusion (Fig. 2a and b). Pleural aspirate analysis showed total cell count of 120,000/mm3 including leucocytes of 1,10,000/mm3 and red blood cells (RBC) 10,000/mm3 with polymorphs 85%, lymphocytes 15%, sugar 20 mg/dl, protein 3.2 gm/dl, albumin 2.3 gm/dl and fluid adenosine deaminase (ADA) of 90. Pleural fluid gram stain revealed few gram-positive cocci in pairs and chains whilst culture analysis showed Streptococcus pyogenes sensitive to ampicillin, azithromycin, cefotaxime and ceftriaxone. Tuberculosis workout including Mantoux, sputum acid fast bacilli (AFB) and gene expert from pleural fluid was negative. USG guided splenic abscess was aspirated, that revealed around 30 ml of pus initially followed by second aspiration of 10 ml the next day. Splenic abscess culture was sterile. The patient was managed with Ceftriaxone/Sulbactam along with Vancomycin and azithromycin according to culture sensitivity reports. Chest X ray gradually improved along with the condition of the patient (Fig. 3). Chest tube removal was done on 5th day of insertion. The patient got discharged on 8th day of admission.