A 69-year-old female patient with known recurrence of esophageal cancer presented with fever and elevated inflammatory markers. In the recent past, a suspicious mediastinal lymph node had been biopsied via bronchoscopy. Consequently, a lymph node abscess developed, leading to blood stream infection (pathogen: Streptococcus anginosus) via a fistula into the superior vena cava. Through a preexisting atrial septal defect, the infection also spread to the brain, causing multiple brain abscesses.