Tick-borne encephalitis (TBE), which is highly endemic to XXXXXXXX, often follows a biphasic course. First phase encompasses fever, malaise, fatigue, myalgias, headache, arthralgias, leukopenia, thrombocytopenia and abnormal liver tests, followed by improvement. About 10% of patients then develop meningitis, meningoencephalitis or meningoencephalomyelitis.A 64-year-old woman, later diagnosed with TBE, presented to primary practice in XXXXXXXX in May 2025 with 10-day history of cough, sneezing, myalgia, nasal and ocular discharge, joint pain and evening sweats. Physical examination, vital parameters and CRP were normal with borderline thrombocytopenia and low lymphocytes. Seven days later she had a fever, headache, high neutrophils and normal CRP. Next day somnolence, frontotemporal headache, neck pain, vertigo, poor concentration, photophobia and high fever developed. Rapid neurological exam was normal.Most literature focuses on TBE cases where CNS infection has already developed and is written from the perspective of tertiary care. One study showed inadequate knowledge of TBE and its symptomatology in primary care doctors. Another concluded that clinical manifestation is often unclear in the initial phase of TBE and in cases manifesting without CNS involvement. There is a lack of similar publications about TBE in primary care.TBE is an important yet challenging diagnosis to make in primary care. Efforts at local and national levels focused on providing an up-to-date structured education about TBE epidemiology, clinical features and laboratory findings to family physicians in high-incidence areas, could increase the number of diagnoses in early stages.Diagnosis of TBE is rarely made in the first phase due to nonspecific presentation. Even in highly endemic areas, many causes of similar disease manifestations must be considered. Fever, malaise, fatigue, myalgia, headache, arthralgia, leukopenia, thrombocytopenia and abnormal liver tests, however, are common and could contribute to improved early recognition of TBE. This case illustrates such nonspecific TBE presentation, where correct diagnosis was established only after CNS involvement.This case report highlights the nonspecific presentation of TBE in the first phase and calls for a structured education about TBE for all family physicians working in high-incidence areas in order to improve early recognition and diagnosis of TBE and thus enhance patient care.