A 44 year old male came to the OPD with complaints of chest pain, breathlessness, fever and left sided back pain History of present illness The patient was asymptomatic one month ago. He was taken to a local government hospital for chest pain and left sided back pain. He was brought to this hospital 10 days ago due to complaints of fever, loss of appetite with heavy alcohol consumption. He complained of pain and discomfort in the chest and upper abdomen which worsens on exertion (talking). He had shortness of breath and was unable to speak comfortably for more than a few minutes. There is left sided pain in his back from the thigh to the lower back. He also had high grade fever with chills and rigors. 20 days ago, he behaved irrationally and was reported to have had hallucinations. There were a few episodes of vomiting with greenish discoloration while he was admitted in the government hospital. Past history No history of diabetes, hypertension, TB, epilepsy or lymphadenopathy.