A previously fit 63-year-old presented drowsy, breathless, and hypotensive. Observations revealed a fever , hypoglycemia, and hypotension . Laboratory investigations showed hemoglobin 144 g/L, white cell count 2.3 × 109/L, neutrophil count 1.9 × 109/L, and platelet count 9 × 109/L. The activated partial thromboplastin time and prothrombin time were prolonged, along with a depressed fibrinogen level, in keeping with DIC. Blood smear showed highly vacuolated neutrophils; there were a large number of both intra- and extra-cellular Gram-positive diplococci (see arrow in left panel of figure) .Later, blood culture revealed Streptococcus pneumonia. Identifying bacteria on a blood smear is a rare, but can lead to a diagnosis before blood cultures become positive.