A 6-year-old previously healthy female from the United States presented with 5 days of high fever to 103F, abdominal pain, and vomiting. Exposure history included recent travel to Russia, Turkey, Yosemite, and the San Diego Zoo, as well as multiple mosquito bites. On admission, she was found to have thrombocytopenia, hematuria, nephrotic range proteinuria and subsequently developed acute kidney injury. Her grandfather was hospitalized shortly after her family’s departure from Russia and diagnosed with hantavirus hemorrhagic fever renal syndrome (HFRS). While extremely rare in the United States, her clinical picture was concerning for HFRS. We also considered other infections with fever and thrombocytopenia such as rickettsia, leptospirosis, dengue, hemolytic uremic syndrome, and other causes of acute glomerulonephritis including lupus nephritis, post-streptococcus glomerulonephritis. After initial complications of acute kidney injury and thrombocytopenia requiring support with intravenous fluids, the patient made an uneventful recovery. Serology tests later resulted positive for Hantavirus. This case describes a rare diagnosis in the United States, and stresses importance of HFRS should be on differential of pediatric patient with fever, thrombocytopenia, and recent travel or exposure.