At presentation, her clinical presentation mimicked palindromic rheumatoid arthritis or other connective tissue diseases with systemic involvement. However, exposure to floods suggested the possibility of acute leptospirosis. Neck stiffness and the haemorrhagic rash with rapid progressive illness suggested other agents of severe sepsis such as meningococci, gonococci, staphylococci or gram negative bacilli. However, the occurrence of the rash later in the illness and non-responsiveness to broad spectrum antibiotics suggested the possibility of rickettsial infection. Therefore, she was treated with anti-rickettsial antibiotics and had a rapid clinical response. She had a strong antibody response to SFGR demonstrated by IFA using R. conorii antigen, confirming the diagnosis. On specific questioning, she revealed that she had tick bites quite frequently when caring for the two dogs.