An 80-year-old female with history of mild chronic obstructive pulmonary disease, mitral valve prolapse, and herniated discs presented to the emergency department (ED) by private vehicle for a facial injury after being struck in the face by a dresser drawer. Leading up to the injury she reported feeling lightheaded, and at the point of losing consciousness she attempted to steady her balance by grabbing a dresser, causing it to fall on her chest pinning her against the wall for approximately five hours. She denied significant pain and noted that the top of her scalp superior to the laceration was insensate. She experienced persistent oozing from the wound and her nose since the injury. A 10-point review of systems was otherwise negative with the exception of fever during the preceding two days to a maximum of 103.3°F on the day of presentation. Notably, she had a tick, which she had removed approximately two weeks prior that was attached for about 24 hours. She was prescribed a one-time dose of 200 milligrams (mg) of doxycycline for Lyme disease prophylaxis, which she had taken on the day of removal by her primary care provider. On exam, vital signs were notable for heart rate of 102 beats per minute and were otherwise unremarkable. She had a six-centimeter laceration over her left upper forehead with evidence of an open fracture of the frontal sinus on exam with bone fragments visible within the wound. Given the mechanism of injury and her age, we ordered computed tomography of the head, maxillofacial, cervical spine, chest, abdomen, and pelvis, which demonstrated left frontal calvarial fractures. Lab work included the following: a complete blood count; complete metabolic panel; troponin; creatinine kinase; prothrombin time and international normalized ratio; tick panel (Lyme disease immunoglobulin G/immunoglobulin M, Ehrlichia chaffeensis polymerase chain reaction [PCR]); Anaplasma phagocytophilum PCR; Babesia microti PCR; respiratory viral panel; coronavirus disease 2019 PCR; and lactic acid. Notable results are shown in. An electrocardiogram demonstrated normal sinus rhythm, and the patient was maintained on the cardiac monitor without event. The patient was treated empirically with tetanus toxoid and ampicillin/sulbactam for coverage of the open sinus fracture. Plastic surgery was consulted for evaluation of the open sinus fracture and facial laceration, which they repaired at bedside in the ED. Intravenous fluids were also administered, and trauma surgery was consulted for admission of the patient to their service for further workup and management. During the hospital course, the patient continued to spike fevers and had worsening thrombocytopenia, hyponatremia, and leukopenia as demonstrated in. To further evaluate for a cardiac etiology of her syncope, an echocardiogram was performed, which did not demonstrate any abnormalities. The Anaplasma phagocytophilum PCR ultimately returned positive on hospital day two revealing the diagnosis. She was started on doxycycline 100 mg twice daily with improvement of symptoms and hematologic parameters, and she was subsequently discharged on hospital day six.