Case 1 question

Case 1

• A 45-year-old male from Malabon presented with history of fever, generalised myalgia and tea coloured urine of one week’s duration.

• Delay in hospitalization was due to the difficulty in transportation during the Ondoy typhoon season of October 2009

• He developed obtundation with generalised tonic-clonic seizures on the previous day of admission.

• There was no history of any significant medical illness in the past.

• He was drowsy, icteric, with bilateral subconjunctival haemorrhages and conjunctival congestion.

• Blood pressure was 140/84 mm Hg. • There was anisocoria with the left pupil being

larger, bilateral brisk deep tendon reflexes and bilateral extensor plantar responses.

• There were no signs of meningeal irritation and the ocular fundi were normal.

• He had hepatomegaly of 2 cms and splenomegaly

• There was no evidence of haematuria or bleeding from intravenous access sites.

• The total leucocyte count was 11,500/mm3 with 75% polymorphs, ESR 100mm/h, serum bilirubin 8.1mg/dL, blood urea 193mg/dL and creatinine 7.3mg/dL(elevated) with a normal platelet count and liver enzymes.

• Prothrombin time (13, control 12 seconds) and activated partial thromboplastin time (32, control 30 seconds) were normal. FDP was <10.

• Non contrast CT scan of the head and abdomen

• Differential diagnosis?

• Diagnosis?

• Discussion