1. Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, systemic inflammatory response syndrome, leptospirosis, Crimean Congo hemorrhagic fever, and hemorrhagic fever with renal syndrome should be considered for the differential diagnosis. 2. Hemorrhagic fever with renal syndrome. hantavirus immunoglobulin (Ig)M and IgG antibodies were positivewith the titer of ≥1:100 using an indirect immunofluorescence test (Hantavirus Mosaic-1, Euroimmun, Germany), and results were confirmed by immunoblot test (Hantavirus Profile 1 EUROLINE IgG and IgM, Euroimmun, Germany). In this case, a 17-year-old adolescent boy was admitted to our hospital with fever, nausea, vomiting, headache, abdominal pain, and generalized myalgia. His clinical course progressed through clinical shock with hypotension, followed by oliguric, polyuric, and recovery phases. In the patient’s laboratory examination, we observed thrombocytopenia, a left shift in leukocyte differential count, elevated levels of hepatic transaminases and lactate dehydrogenase, hypoalbuminemia, microscopic hematuria, pyuria, hyposthenuria, and mild proteinuria. He was living in a rural and endemic area for hantavirus infection, and when we repeated the history regarding possible rodent exposure, his family stated that he walked barefoot in the forested area infested with rodent feces and he had excoriee lesions on his feet and soles. These findings led us to the consideration of hemorrhagic fever with renal syndrome, and on the 6th day of hospitalization, hantavirus infection was proven serologically. Due to the presence of fever, thrombocytopenia, and renal failure without laboratory findings of any bacterial or viral infection, in the differential diagnosis, we also considered leptospirosis and Crimean Congo hemorrhagic fever, which are both endemic in our country. The results of serological and reverse transcriptase real-time polymerase chain reaction (PCR) tests were negative for both infections.