In late autumn 2008, a 49-year old woman died. She suffered from type 1 diabetes, familial mediterranean fever, peripheral neuropathy, and foot ulcers. In February 2008, she was admitted to the Department of Infectious Diseases, University Hospital in Linköping for amputation of her left foot and received piperacillin-tazobactam intravenously and a blood transfusion post-operatively (Fig. 1). Despite this, her clinical status deteriorated critically within one week and she developed acute liver and renal insufficiency. The suggested diagnosis was hemolytic uremic syndrome and the result of an allergic reaction to piperacillin-tazobactam. She was treated with plasmapheresis, corticosteroids, imipenem, and metronidazole. The culture from the foot ulcer prior to amputation revealed growth of Enterococcus fecalis (E. fecalis) together with several gram-negative bacterial strains. She recovered partially, but the renal function was permanently destroyed and she was treated with hemodialysis and released on March 11th 2008. On March 24th, she was readmitted to the Department of Infectious Diseases for fever, shivering, and diarrhea. The blood cultures revealed growth of E. fecalis and Staphylococcus aureus. She was transferred to the Department of Cardiology, University Hospital in Linköping for mitral valve endocarditis and underwent surgery for biological valve prosthesis. The antibiotic treatment was composed of meropenem, vancomycin, and clindamycin and continued for 8 weeks. The heart valve culture revealed E. fecalis. She was dismissed on June 5th 2008 with moxifloxacin. She developed vomiting after 5 days at home and was readmitted on June 23rd. Blood cultures revealed growth of E. fecalis again and she was treated with vancomycin. Echocardiography showed a paravalvular leak that was treated at the Department of Cardiology. On July 28th 2008, while still on the ward, she experienced sudden temporary blindness. A computed tomography (CT) scan did not show new pathologic signs that might explain the symptom. Doktacillin was complementary to vancomycin in the treatment. However, she developed hemolytic anemia and antibiotic therapy was interrupted on August 8th. She suffered from anxiety, depression, severe heart failure, pain, and loss of vision, but she had no fever. Blood tests revealed a high sedimentation rate, anemia, high white blood cell count, and a high level of C-reactive protein. Blood cultures from eight different occasions yielded no growth. Two short episodes of antibiotic therapy with tigecycline and imipenem were interrupted due to negative blood cultures. The symptoms were judged as Mediterranean fever and she was transferred to the Department of Nephrology with high dose of corticosteroids on October 1st. She died October 13th due to septic shock and E. fecalis grew in all blood cultures that were taken before she died.Fig. 1Chronic ulcer in a patient with persistent Enterococcus fecalis infection and organ dysfunction in 2006