Step-wise rising fever, bacteremia, diarrhea associated with abdominal pain and hepatosplenomegaly are the usual manifestations. We report a case of typhoid fever with sore throat as an integral part of the clinical picture. CASE INFORMATION: A 21-year-old immigrant male from Ecuador presented with a seven-day history of sore throat associated with a foreign body sensation and dysphagia for solid foods. Three days prior to presentation, in addition to his sorethroat, the patient complained of vomiting, diarrhea, mild abdominal discomfort, myalgias, fatigue and subjective fevers. On examination, his temperature was 94.68F with a pulse rate of 66 beats/minute. The oropharynx was markedly erythematous. The monospot test and rapid streptococcal screen were non-reactive. A diagnosis of acute viral syndrome with pharyngitis was made and he was treated symptomatically with Ibuprofen. He returned to the emergency department two days later with worsening sore throat, fever, new onset of low back pain, and mild abdominal discomfort with nausea. Physical examination revealed a temperature of 103.28F, pulse rate of 60 beats/minute, mild peri-umbilical tenderness and splenomegaly. The patient was hospitalized and started on intravenous fluids and oral Ciprofloxacin 750 mg twice daily. His fever subsided and he showed significant symptomatic improvement on antibiotic therapy. On the fourth day of hospitalization, blood cultures yielded Salmonella Typhi. He was discharged home on day five with two weeks of ciprofloxacin. IMPLICATIONS/DISCUSSION: Conclusion: Once considered an integral part of the symptomatology of typhoid fever, sore throat is infrequently reported, perhaps due to differences in causative strains, less emphasis on documentation of all symptoms and early and effective treatment in the antibiotic era. Physicians should be aware that typhoid fever could present as pharyngitis and should be considered especially in immigrants, to aid in early diagnosis and treatment. 