A white-tailed deer (Odocoileus virginianus) fawn was collected in Missouri (USA) and submitted for diagnostic evaluation. Necropsy and histologic examination revealed severe Amblyomma americanum infestation, pronounced icterus, and marked hemosiderin deposition in the liver and spleen. Whole blood evaluation revealed a normocytic normochromic anemia and a piroplasm parasitemia of approximately 70%. The piroplasm was identified as Theileria cervi by polymerase chain reaction and sequencing of the V4 variable region of the 18S rRNA gene from a paraffin-embedded section of lung. Although T. cervi parasitemias have been commonly reported in healthy white-tailed deer, the severe parasitemia in this fawn may have contributed to overt clinical disease, perhaps as part of a combined malnutrition and parasitemia syndrome.