Upon the patient’s arrival at our hospital, the concern was for worsening mentation, weakness, and sepsis, secondary to Streptococcus meningitis with an intramedullary abscess from C2 through C5. The patient was placed on high-dose intravenous steroids to reduce spinal cord swelling. He was placed on azithromycin, ceftriaxone, and vancomycin for broad antibiotic coverage. Concerns for pneumonia versus influenza arose because of findings in the chest x-ray obtained upon admission, and the patient was placed on oseltamivir. An arterial line, a minimally invasive hemodynamic monitor, a central venous catheter, an endotracheal tube, and a mixed venous oxygen saturation monitor were placed. Daily procalcitonin and C-reactive protein levels were obtained to monitor for treatment response. Blood and cerebrospinal fluid cultures were obtained. The patient was placed on a bicarbonate drip for metabolic acidosis but continued to have declining renal function. The patient was subsequently placed on continuous renal replacement therapy.