A 66-year-old man visited our hospital complaining of fever with chill which has started three days prior. The patient had a history of appendectomy for appendicitis, hypertension, hyperuricemia, and gastroesophageal reflux disease, which were managed with allopurinol 100 mg once a daily, amlodipine 5 mg once a daily, and vonoprazan 20 mg once a daily. The patient had no history of dental treatment in the past decade. The patient drank about 2 glasses of Awamori, a type of rice wine with 30-40 % alcohol content unique to Okinawa, daily and has smoked 60 cigarettes a day for past 44 years. He denied having sexual intercourse in the past year and denied having homosexual intercourse. Vital signs on arrival showed a temperature of 39.7 , heart rate of 128 beat per minute, blood pressure of 106/62 mmHg, SpO2 of 95 % in room air. Physical examination showed that his conscious was clear, and his abdomen was soft and had no significant tenderness. Laboratory tests revealed high hepatic enzymes and C-reactive protein (CRP), and increased white blood cells with neutrocyte dominant (Table 1). Computed tomography (CT) scan revealed that the small hypodense area in S4 and a huge hypodense area with the well-defined boundary of more than 100 mm in diameter in S5-6 (Fig. 1). Initially, we suspected metastatic liver tumor, but we could not rule out liver abscess, thus the patient was admitted to our hospital to start intravenous administration of meropenem 1.0 g per 8 h after collected two sets of blood culture. On the hospital day 8, blood culture on admission day reported Streptococcus intermedius was positive in both two sets. In view of the findings of bacteremia and low-density area in the liver on CT scan, we finally diagnosed pyogenic liver abscess. We could not point out any other abscesses through head and body imaging. Based on bacterial susceptibility, antibiotics was changed from meropenem to ceftriaxone 2 g per a day plus metronidazole 500 mg per 8 h. We had recommended percutaneous drainage to the patient, but he refused because of needle phobia, thus we continue antibiotics alone. His fever resolved on the day 5 and CRP was on downtrend with the treatment (Fig. 2). Two sets of blood cultures taken on days 8 and 15 were both negative. On the day 27, the patient again had a fever of 38.3 degrees, and tested for SARS-CoV-2 antigen was positive. Because of the outbreak in the hospital, he was diagnosed with nosocomial COVID-19, however his symptom was recovered within 2 days. On day 29, blood test showed white blood cell count of 2900/microL, whose percentages of neutrophil was 40.7 %. Because of the gradual decrease in white blood cell count, drug-induced neutropenia was suspected, and vonoprazan was discontinued and filgrastim 75 microg was administered. On the day 40, neutrophil counts were recovered to 4400/microL with 52 % of neutrocyte. A total of 6 weeks of antimicrobial therapy was completed on day 40, and we confirmed that liver abscess had been almost completely diminished on enhanced CT scan (Fig. 1). Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) were performed to search the bacterial entry. There was no suspicious findings of on esophagus and stomach, but there were the brownish stains under the patient's teeth, suggesting that periodontal disease (Fig. 3). CS revealed diverticulum and 0-Isp polyp on sigmoid colon; pathological diagnosis was low grade tubular adenoma. After discharge from our hospital on day 42, the patient was followed up in an outpatient clinic for 3 months. There was no recurrence of liver abscess and no elevation of CRP.