A 72-year-old male presented with fever and abdominal erythema (figure 1). His medical history included an aortic graft stent (open procedure) in 2009 because of an abdominal aortic aneurysm and a myocardial infarction in 2006. Four days earlier the general practitioner started amoxicillin/clavulanic acid because of a fever, abdominal erythema and suspicion of erysipelas. At presentation signs of septic shock including high fever, high inflammation parameters and hypotension not responding to fluid resuscitation were present but he only experienced mild abdominal pain. During palpation of the abdominal erythema an underlying infiltrate was discovered and crepitus was found, suggesting the presence of subcutaneous emphysema.