MRCP2-2946
A 25-year-old patient presented to their GP with fever and epistaxis. The fever had started 6 days earlier and was accompanied by a headache and malaise. After being prescribed amoxicillin for 3 days without improvement, the patient became so ill that they refused to eat and started vomiting.
Their medical history included mumps at the age of nine, and their father had been diagnosed with liver cirrhosis 2 years ago due to excessive alcohol consumption. The patient is a regular smoker for the last 10 years and lives in a dorm. Two weeks earlier, they had been in rural Central Africa as a reporter covering the conflict there. They denied being vaccinated for any disease before going there but did take anti-malarial tablets.
On examination, the patient appeared ill with a temperature of 38ºC and jaundice. Eye examination revealed conjunctival hemorrhages on both eyes. All other systems were normal.
The following investigations had been requested:
Hb 13 g/dl
platelets 170 * 10^9/l
WBC 4 * 10^9/l
MCV 85 fl
MCH 0.4 fmol/cell
MCHC 20 mmol/l
Na+ 135 mmol/l
K+ 4 mmol/l
Creatinine 80 µmol/l
Urea 3 mmol/l
ESR 60 mm/hr
Alkaline phosphatase 100 IU/l
Alanine transaminase 400 IU/l
Aspartate transaminase 200 IU/l
Bilirubin 25 µmol/l (direct 18 umol/l)
Serum albumin 40 g/l
Prothrombin time prolonged
Partial thrompoblastin time prolonged
Urine analysis Albumin + ,acetone ++ ,bile pigment ++,urinary urobilinogen +
Thick Blood film for malaria negative
What is the most likely diagnosis?