A Febrile Return from Mecca: is it the obvious?

We describe a 53-year-old female patient with diabetes mellitus and mild hypertension who made the ritual Hajj pilgrimage to Mecca. On the return trip to Jerusalem, she developed a respiratory illness, high fever and chills. We describe the initial and subsequent management of this patient, epidemiological aspects and the surprising final diagnosis. The take-home messages are: first, emergency department staff should demonstrate a high index of suspicion and put patients in isolation who meet specific case definition criteria. Second, even if a certain disease, in this instance MERS-CoV is the obvious diagnosis, open-mindedness and a differential diagnosis are always necessary in order to avoid misdiagnosis.