CASE PRESENTATION: A 71-year-old Caucasian female presented to the ED with altered mental status. On presentation, she was found to have atrial fibrillation with rapid ventricular response, with a heart rate of 227. History revealed 3 days of back pain, followed by subjective fevers and proximal muscle weakness. Labs showed pancytopenia with bandemia, acute kidney injury and elevated transaminases. Integumentary exam showed a maculopapular rash noted encompassing only the chest, and extremities. Neurological exam showed dysarthria with some word finding difficulties. Diagnosis of severe sepsis with multiorgan dysfunction was made and the patient was admitted to the critical care service. All etiologies were considered, including viral, parasitic, and bacterial. After talks with the family, it became apparent that the patient had recent exposure to wildlife and ticks 1 week prior while hiking on Sapelo Island, Georgia. The patient was placed on Doxycycline and Ceftriaxone for possible tick-bourne illness. Over the next few days, her status began to improve and her laboratory abnormalities all continued to trend to normalcy. Serologies returned, showing Ehrlichia Chaffeensis to be the causative agent with titers of >1:1024.