A 74 year old gentleman is admitted to the critical care unit following a 3 week admission on the medical wards with pyrexia, malaise, lymphadenopathy and thrombocytopenia. A diagnosis of sepsis of unknown origin has been made and he has been treated with multiple courses of antibiotics. No clear focus of infection has been ascertained. He has now developed multi-organ failure with a worsening transaminitis, an acute kidney injury, an increasing CRP and a pancytopenia.