One week prior to admission, the patient noted posterior neck swelling that was inflamed and increasing in size. He was experiencing fever and chills. The patient flew to Hawaii from his native country and arrived at the hospital directly from the airport. The patient complained of headache, swelling and pain, which had become worse despite oral antibiotics. The patient had a history of diabetes, hypertension and hyperlipidemia. On admission, a large, firm lesion of 6 to 8 cm diameter with purulent discharge was noted on his posterior head. A CT scan indicated moderate posterior lower scalp/upper neck subcutaneous stranding and edema, suspicious for cellulitis/soft tissue infection that extended down to posterior paraspinal muscles. White blood cell count was 20,000; blood cultures were positive.