Fever from the shadows: Borrelia duttonii in a migrant in Italy

In a striking diagnostic breakthrough, a Senegalese man arrived at SS. Annunziata Hospital in Chieti gripped by relentless high fever, throbbing headache, vomiting, right hypochondrium tenderness, lower limb myalgias, generalized lymphadenopathy, conjunctival injection, and photophobia-signaling a systemic infection with neurologic red flags. Labs showed thrombocytopenia, elevated CRP, procalcitonin, and indirect hyperbilirubinemia; lumbar puncture was negative. The game-changer came during peak fever: an extraordinarily rare visual spectacle on peripheral blood smear-motile spirochetes "dancing" under the microscope, a near-mythical "smoking gun" for Borrelia species, far less common than for Plasmodium. Real-time PCR confirmed Borrelia duttonii, the culprit of soft tick-borne relapsing fever This case highlights that in this world we must always be ready to make unusual diagnoses.