African tick bite fever (ATBF) is a spotted fever group rickettsiosis caused by Rickettsia africae and is often identified among travelers returning from sub-Saharan Africa. Clinical presentation may be mild or nonspecific, often delaying diagnosis despite characteristic findings such as inoculation eschars. A 52-year-old male presented to the preoperative holding area prior to a scheduled left-sided inguinal hernia repair after recently returning from a game-hunting trip to Africa. During preoperative intake, he was noted to have a fever of 106°F despite being otherwise asymptomatic. Physical examination revealed two black eschars on the patient’s back and right shin. Given the presence of high-grade fever, the scheduled procedure was canceled, and the patient was discharged for outpatient evaluation. He was subsequently treated with a 10-day course of doxycycline for suspected African tick bite fever. At two-week follow-up, the patient remained asymptomatic, his fever had resolved, and repeat preoperative evaluation was unremarkable. Surgical repair of the inguinal hernia was performed without complications. This case underscores the importance of maintaining clinical suspicion for ATBF in returning travelers and highlights the diagnostic value of inoculation eschars, even in the absence of systemic symptoms. Early recognition and prompt doxycycline therapy can result in rapid clinical resolution and prevent unnecessary delays in care.
