MRCP2-2536
A 25-year-old medical student presented to hospital four weeks after returning from a two month elective period in Africa. She gave a ten day history of a non-productive cough and a fever. She had seen her general practitioner the previous day and had been started on a course of amoxicillin.
She had spent her elective in Tanzania, but had also spent time travelling in Uganda and Rwanda. She developed a febrile illness with diarrhoea two weeks before returning to the United Kingdom and was seen by a doctor in Uganda and prescribed a course of metronidazole for presumed amoebiasis and her symptoms settled within three days. There was no other past history of note.
On examination she was febrile (38.7°C) and an urticarial rash was visible over the trunk. There was no palpable lymphadenopathy. Her pulse was 95 beats per minute in sinus rhythm and blood pressure 120/70 mmHg. Her chest was clear. Her abdomen was soft and slightly tender in the right hypochondrium, where the tip of the liver could be palpated.
Investigations showed:
Haemoglobin 130 g/L (120-160)
White cell count 8.5 ×109/L (4.0-11.0)
Neutrophils 4.8 ×109/L (1.5-7.0)
Lymphocytes 2.0 ×109/L (1.5-4.0)
Monocytes 0.2 ×109/L (<0.8)
Eosinophils 1.3 ×109/L (0.04-0.4)
Basophils 0.1 ×109/L (<0.1)
Platelets 300 ×109/L (150-400)
Chest x ray: Normal –
Amoebic serology: Negative –
What is the most likely diagnosis?