BACKGROUND Murine typhus is a rare bacterial infection caused by Rickettsia typhi, which is transmitted from rodents to humans through the infected Xenopsylla cheopis flea. The disease presentation is often non-specific, leading to unnecessary tests, and a delay in diagnosis and treatment. CASE REPORT A report is presented of a 22-year-old, previously healthy man, who presented with several symptoms and signs that increased in severity, requiring admission to the medical intensive care unit (MICU). After an extensive bacterial and viral laboratory workup, IgM and IgG titers confirmed the diagnosis of murine typhus due to infection by Rickettsia typhi. The patient was treated with doxycycline, which resulted in significant clinical improvement. CONCLUSIONS Murine typhus can present with a characteristic triad of fever, headache, and rash but also with other symptoms and signs and can vary in severity. Given its increasing prevalence in coastal cities, awareness of this infection and early diagnosis and treatment with doxycycline can reduce patient morbidity.