A 23-year-old man with no known co-morbidities presented in the Emergency Department at a Tertiary Care Hospital in Karachi with multiple complaints of neck swelling for 1 year, fever for 1 month, and generalized weakness for 1 week. He was a resident of Khuzdar, unmarried, and a final-year student of Doctor of Veterinary Medicine. On detailed history, the single neck swelling presented anteriorly and was not associated with any joint swelling, morning stiffness, or tenderness in small joints. It also regressed with time. However, he then noticed another static swelling on the right side of the neck in close proximity to the previous one. Fever was reported as intermittent and documented up to 104 F. It was associated with rigors and chills but subsided after oral paracetamol. It was associated with severe body aches and joint pain involving the wrists, elbows, and knees bilaterally. No diurnal variation or night sweats were accounted for, nor was any rash or oral ulcer. There was no history of Raynaud's phenomenon, burning micturition, cough, or loose stools. On further inquiry, it was revealed that he had a pet cat for a duration of 1 year in 2020 and is a student of Doctor of Veterinary Medicine (DVM), reports positive for exposure to various animals. His personal history revealed no addictions, but there was a history of sexual contact. On examination, three to four swellings were accounted for in the right posterior cervical region, the largest one having dimensions of ~2.0 x 1.0 cm. They were non-tender, non-erythematous, firm, and immobile, with no discharging sinus. Two small swellings were also noted bilaterally in the inguinal region. These were also found to be non-tender, non-erythematous, firm, and immobile with no discharging sinus. They measured ~1.0 x 1.0 cm. Blood pressure was recorded as 80/40 mm Hg, pulse 92 beats/min, oxygen saturation 98% on room air, and temperature as afebrile in the Emergency Department. On systemic examination, the abdomen was found to be soft and non-tender, with no visceromegaly noted; the chest, cardiovascular system, and central nervous system were also found to be unremarkable. The hospital course was initiated by giving IV fluids and commencing ionotropic drugs (noradrenaline) to raise his blood pressure, and he was hospitalized. Meropenem 1 g was started IV three times a day (TDS) secondary to high total leukocyte count (TLC = 49) and procalcitonin (PCT = 8.17). As the diagnosis was uncertain and the patient presented with fever, to rule out infective endocarditis and vegetation, echocardiography was scheduled, which was found to be unremarkable. Next, the general surgery team was consulted for an excisional biopsy of the right cervical lymph node. He was then stepped down to a private room as blood pressure started to show improvement, and ionotropic support was eventually tapered off. Azithromycin 500 mg was added to the treatment regime as there was no improvement in fever. The Infectious Diseases Department next advised VDRL and HIV serology (which came out to be negative), and azithromycin was switched to an injection of ciprofloxacin 500 mg IV twice daily. Histopathology ruled out tuberculosis and malignancy, and as fever started to space out, meropenem and ciprofloxacin were continued. After about 5-6 days, the histopathology department came up with the diagnosis of cat-scratch disease. The patient was fever-free for 2 days, clinically and vitally stable, and discharged on doxycycline 100 mg and rifampicin 300 mg twice daily for 6 weeks. Figure 1 shows a section of a lymph node showing areas of necrosis and abscess surrounded by palisading histiocytes along with capsular and subcapsular granulomas. Table 1 highlights results of important laboratory investigations to reach a diagnosis.