Introduction: Approximately 400 cases of typhoid fever are diagnosed in the U.S. each year. The majority of cases are found in patients who acquired the illness while traveling to endemic countries; however, 25% of cases are acquired domestically. In most cases, patients complain of fever, headache, malaise, anorexia, abdominal pain, diarrhea, or constipation. Classic exam findings include a coated tongue (typhoid tongue), rose spots, fever, relative bradycardia, hepatosplenomegly, and altered mental status. Common laboratory abnormalities of infected patients include anemia, and leukopenia or leukocytosis. Typical time of exposure to presentation is usually 5-21 days. Here, we report a case of a 65-year-old Bangladeshi male with no significant past medical history who presented with 5 days of fever and rigors. He traveled to the U.S. from Bangladesh 29 days prior to onset of fever. He denied any history of headache, lethargy, abdominal pain, diarrhea, constipation, or change in stool color. He also denied taking any medication for the past 3 months, including over-the-counter medications. He reported a remote history of alcohol use with 3-4 hard liquor beverages daily, but has abstained for greater than 5 years. Vital signs were significant for fever of 102.1°F with normal blood pressure and heart rate. The only abnormality on physical exam was dry oral mucous membranes. Positive lab findings were elevated liver enzymes with AST 97 and ALT 100. All other laboratory values were within normal range, including CBC and hepatitis serology. Chest x-ray was significant for bilateral lower lobe infiltrates. Initially, he was started on broad spectrum antibiotics with vancomycin and cefepime due to concern for possible pneumonia. To determine the cause of transaminitis, a right upper quadrant ultrasound was performed, which did not show any abnormalities. Due to ongoing fevers on broad spectrum antibiotics, a CT scan of the abdomen was done to rule out abscess, which showed multiple enlarged mesenteric lymph nodes, but no other abnormalities. Blood cultures resulted positive for Salmonella paratyphi. Antibiotics were downgraded to ciprofloxacin, and subsequently his liver enzymes normalized, fever subsidized, and he was discharged home on a 7-day course of levofloxacin. As noted above, the majority of typhoid fever cases present with GI symptoms; however, this case presents rare findings of isolated fever and rigors and a history notable for an abnormally long period between exposure and onset of symptoms. Therefore, the diagnosis of typhoid fever should be considered in the differential for a patient with possible recent exposure and minimal signs and symptoms on presentation.