Tularemia. Only case I have ever seen. In Arkansas. In practice for 20 years. Have seen quite a few cases of RMSF. Diagnosed with febrile agglutin tests. His were very high according to the infectious dz. doctor. She said his type of illness only occurred in about 15% of cases. It did take about 5 days to make the diagnosis bacause he presented with acute cholecystitis. But he kept running fever so after thinking what else could it be I ran the tests. I am glad I did. I wasn't expecting Tularemia. I was think maybe RMSF and the GB was just a conincidence.
One thing that I think we will see more and more of is hepatic amoebiasis. I had a case of this some years back in an illigal alien. He came in with what for the world looked like acute cholecystitis and when we got in he had amebic abcess of the liver with the anchovie paste abcess which is reported as characteristic of amoebic liver abcess. It was very interesting. He responded well to drainage and flagyl.