Serologic work-up for infection and inflammation included blood culture, rapid plasma reagin, fluorescent treponemal antibody-absorption, tuberculosis quantiferon gold, chest X-ray, angiotensin-converting enzyme, tick-borne disease panel, sedimentation rate, C-reactive protein, and human leukocyte antigen B27 which all were within normal limits. Here, ACE is linked to tick-borne infectious disease.