A case study of a patient returning from sub-Saharan Africa with a febrile illness and symptoms reminiscent of a previous malarial infection is discussed. The patient had a relative bradycardia with respect to febrile episodes, a transient macular rash and thrombocytopenia. The illness was conservatively managed for 1 month before positive Rickettsia serology and PCR results were reported. The patient was then treated with doxycycline with a complete resolution of symptoms.