African Tick-bite Fever

A 41 year old male with no significant past medical history presented to his primary care clinic with new onset severe headaches, subjective fevers, malaise, and chills since returning from a 7-day safari trip to South Africa. While on safari in northeastern South Africa, he resided in rural lodging and went on daily runs through tall grassy fields. He recalls a “bite” on his right medial ankle mid-way through his trip, but did not appreciate a tick at the site. The affected region developed a dark necrotic center with mild surrounding erythema, but he was otherwise asymptomatic for the remainder of his trip.