School nurses occasionally deal with students presenting with serious infections associated with common chief complaints. Although rare, the implications of missing the signs and symptoms of these infections are potentially life-threatening and devastating, with both immediate and long-term complications. Rapid recognition and stabilization, with immediate transfer to the closest emergency department via emergency medical services for antibiotic administration, is the key to reducing morbidity and mortality associated with these serious infections. We discuss three students presenting with febrile illnesses associated with chest pain, headache, and back pain, focusing on the initial assessment and management of these students and their common presenting complaints.