Abstract: 81 year-old male with degenerative joint disease. The patient underwent total right knee joint replacement in January ’98, and had been doing well until he presented in July ’98 with a two week history of increasing pain and swelling in his right knee associated with a low-grade fever and chills. The patient is a farmer from Missouri and he recalled skinning squirrels in June, and he has had two episodes of tick bites three weeks before presentation. Physical examination reveals no skin infection or lymphadenopathy. Examination of the right knee showed a tender, swollen joint with 2+ effusion and restriction of motion, the patient had knee joint fluid aspiration and the culture grew. Francisella tularensis, with a negative blood culture, the patient was admitted for intravenous Gentamicin and underwent surgical irrigation and debridement of his right knee. He recovered completely after three weeks of IV Gentamicin and oral ciprofloxacin.