A 69 year-old male with a past medical history of hyperlipidemia, GERD, and transitional cell carcinoma of the bladder currently in remission was admitted to the hospital with increasing fatigue, arthralgias, and myalgias. He noted that his symptoms began approximately four weeks prior to admission after working outside in his yard and on his swimming pool. He stated that one week later he developed red blotches on his thighs, abdomen and chest followed by arthralgias and myalgias. He noted there were ticks where he was working but could not recall a definite tick bite, nor did he find evidence of one. On further questioning he revealed that his neighbor had Lyme disease in the past, and his dog also had Lyme disease. He presented to his primary care physician three weeks later with myalgias in his arms, shoulders, elbows, and thighs bilaterally.