Hepatic abscesses are a relatively uncommon occurrence in North America. They are seen in approximately 2.3 cases per 100,000 with higher rates found among men than women. They do, however, represent a serious risk to patients. Mortality at one time approached 77%, but newer population based studies have estimated rates at closer to 6%.1–3 We present a case of a healthy young patient who presents only with upper back pain, underlining the diagnostic challenge inherent in the disease.