We report an unusual case of post-travel fever, extreme headache, chills, nausea, vomiting, profuse diarrhea and clinical sepsis. The patient had been in excellent health prior to a month-long rotation in Samoa and American Samoa where he had direct patient contact. He also traveled to remote villages, frequently ate local food and swam in both fresh and saltwater. Symptoms developed 5 days post return and on day eight the patient was hospitalized and resuscitated with intravenous fluids. Antibiotics administered empirically included IV levofloxacin, IV metronidazole and IV vancomycin. His condition gradually improved with normalization of lab values. However AST and ALT levels remained elevated. Despite advances in diagnosis, post-travel fevers remain a challenging clinical problem. Lessons learned from this patient's care will inform readers of current methods of diagnosis and treatment. Implications for travel to remote locales are discussed.