Quratul Ain Tahira, Rehana M Sukhera, Abbas Hayat.
Crimean congo hemorrhagic fever.
Pak Armed Forces Med J Jan ;57(4):332-4.

A 45 years old man, livestock trader, was admitted with high-grade remittent fever for 8 days and hematemesis and malena for one day. On physical examination he was in shock with a purpuric rash on his body and he was bleeding from gums. Liver was not enlarged. Spleen was mildly enlarged and there was no free fluid in the abdomen. Signs of meningial irritation were absent and there was no focal neurological deficit. A provisional diagnosis of septicemia with disseminated intravascular coagulation was made. The patient did not respond to treatment and continued to bleed from multiple sites. At this time, the case was reviewed and Crimean Congo hemorrhagic fever was considered a strong possibility. A blood sample was taken for confirmation of the disease. On the morning of Sept 22; he had generalized tonic clonic fits and died approximately 48 hours after admission on day 10 of illness. Subsequently, the result of blood sample came out to be positive for IgM antibodies and RNA for CCHF virus by PCR.

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