Febrile disease in a Bulgarian emigrant with acute renal failure, thrombocytopenia, bilateral subconjunctival haemorrhage and hypoxemia

Abstract

A 23-year-old male was transferred to our tertiary hospital, with working diagnosis of disseminated intravascular coagulopathy DIC). He had originally presented 5 days earlier at a rural hospital n Zakynthos island, Greece, complaining of fever (39.2 ◦C), chills nd mild frontal headache lasting for 24 h. The patient reported nausea and vomiting with scant blood treaking, along with two fainting episodes during the past days. He lso mentioned dark urine during the past 24 h. His social history evealed that he cared for livestock in Bulgaria, until the previous onth. Upon admission to our department, blood pressure was 152/102 nd pulse 127 bpm. Physical examination revealed bilateral subonjunctival haemorrhage (Fig. 1) and a petechial rash on his runk. The right lung had decreased breath sounds, and three mall, hard, mobile lymph nodes were detected in the right xilla. Early laboratory analysis of blood and urine (Table 1) showed ignificant thrombocytopenia, renal failure and proteinuria. Labratory and blood smear findings did not support the initial orking diagnosis of DIC. Leptospirosis was considered the ext most likely diagnosis due to matching clinical findings nd its relatively high incidence in Greece (3 per million opulation annually).1 Respective antibiotic therapy was initited. Two days post admission, the patient developed right flank ain, deep abdominal tenderness (with rebound) and constipation.