Acute pharyngitis is one of the most common reasons for seeking medical advice, leading to more than 15 million office visits per year in the United States. The etiologic agents include many microorganisms: viruses, bacteria, fungi, and parasites. Noninfectious causes such as allergy, trauma, neoplasia, and others have also been suggested. Rickettsia typhi , the causative agent of murine typhus, is not commonly recognized as a cause of acute exudative pharyngitis. Miller and Beeson reviewed 126 cases of murine typhus, 52 of which had diffuse reddening of the throat but none had exudative pharyngitis. This report describes a rare case of acute endemic (murine) typhus presenting as acute exudative tonsillopharyngitis. A 26-year-old man presented to our center with a 5-day history of high grade fever (reaching 40°C) and sore throat associated with generalized fatigue, diffuse arthralgias, myalgias, and headache. http://www.entnet.org/journal/casereports/OTO-20.pdf/