Summer is fast approaching (woohoo)! For many of us living in endemic areas, that means we need to consider tick borne illnesses in many of our differentials of patients with flu-like illnesses and possibly a rash. Lyme disease and Rocky Mountain Spotted Fever are often the diseases that we remember easily. Below are some pearls to help clinch the diagnosis of some of the lesser known tick borne illnesses or, in some cases, answer a test question correctly!