CASE PRESENTATION: A 57 year old Japanese woman with a past medical history of Hashimoto’s thyroiditis presented to the emergency department with 7 days of fever, sore throat, arthralgias, rash, neck stiffness and headache. Physical exam revealed hypotension, erythematous rash and confusion. She was admitted to the Intensive Care Unit (ICU) and started on intravenous fluids, norepinephrine drip and antibiotics. Laboratory testing showed a neutrophilic leukocytosis, slight anemia, azotemia and transaminitis. A lumbar puncture was performed but was negative for any signs of inflammation or infection. Significant laboratory results included a positive parvovirus PCR (IgM/IgG were negative) and a positive PCR elevation of HHV-6. Erythrocyte sedimentation rate was elevated at 91mm/h, C-reactive protein at 33mg/dL and ferritin at 1919ng/mL. She remained in the ICU for 3 days requiring vasopressor support. Her rash began to fade and cultures returned negative but she continued have neck stiffness, fever and headaches. Repeat lumbar puncture was again negative for infection, so non-infectious etiologies were considered. She was treated with high dose prednisone. Overnight, her symptoms improved. The sedimentation rate remained elevated but her azotemia and transaminitis resolved. Ultimately, her condition stabilized and she was discharged with a steroid taper.