We describe a rare case of a young patient with SD who presented with an acute relapsing pattern of MAS. Following intensive treatment, she recovered and has remained free of symptoms for the past 20 months. A 15- year-old Iraqi girl was admitted with a fever of 39°C which lasted for more than two weeks. A week prior to admission, she had complained of a sore throat, fever and maculopapular rash on her limbs, abdomen, palms and back. The patient was treated with doxycycline 150 mg twice a day, but due to her prolonged fever she was hospitalized. On admission, her physical examination was unremarkable. However, her blood count revealed leukocytosis of 23,000 (4000 to 10,000/mm 3 ), with 90% neutrophils, hemoglobin of 12.6 Gr% (12 to 16 Gr% with MCV 75 fl (77 to 91 fl)), erythrocyte sedimentation rate (ESR) at 92 mm/1 hour, C-reactive protein (CRP) at 16 (0-1 mg%) and serum ferritin level at 2267 ng/ml (10 to 120 ng/ml).