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A 75-year-old retired farmer living in rural Saskatchewan, presented with fever, night sweats, and fatigue for three weeks and a two-day history of bilateral calf pain and lower extremity weakness in August. He reported occasional shortness of breath, but denied cough, altered bowel habit, chills, rash, arthralgia, or headache. He had no recent travel history or sick contacts, though he did have contact with animals including several miniature horses and a pet rabbit on his farm, and frequent attendance at horse shows. In the weeks prior to his presentation he had been working on the farm cleaning out an old barn. There was a positive remote history of multiple tick bites. Past medical history included hypertension, benign prostatic hypertrophy, rheumatoid arthritis, chronic obstructive pulmonary disease, atrial fibrillation, diverticulosis, and granulomatosis with polyangiitis, which had been symptomatic in the past with scleritis and upper airway inflammation but had been quiescent recently. Patient was taking methotrexate 10mg/week. At his home hospital the patient’s white blood cell count was 17.9×109/L (4.1-10.0) and temperature was 37.2°C, reaching a high of over 38°C. Urine and blood cultures were negative. He was treated empirically with gentamicin 540mg IV q24h and ceftriaxone 2gm q12h. Despite this antibiotic regimen, the patient’s condition did not improve and his temperature continued to spike. After three days in hospital, the patient developed pitting edema to the distal legs bilaterally and weakness to the distal arms and neck. The patient was transferred to our center for further assessment. On evaluation at our hospital, he appeared non-toxic. Vital signs were within normal limits. There was a grade two systolic murmur at the right upper sternal border and marked pitting edema to the legs bilaterally. No lymphadenopathy or rash was present; respiratory and abdominal examinations were unremarkable. Neurologic examinations revealed generalized weakness and diffuse hyporeflexia. Laboratory results are outlined in Table 1