Abstract
Febrile illnesses with associated laboratory abnormalities can have a wide differential diagnosis. While geographic location and seasonality can inform a workup, the overall incidence of specific conditions can lead to anchoring biases. Tick-borne illnesses are an important pathology to consider, despite known patterns and occurrences.Here, we discuss the case of a 42-year-old male pediatrician living in the central Pennsylvania area, with no significant past medical history, presenting with headache, diffuse myalgias, and several laboratory abnormalities, ultimately found to have ehrlichiosis in November, though not in an endemic region or the expected time of the year.