Skip to content

Content

Home
Patient case
Patient case: Viral Hemorrhagic Fever

Patient case: Viral Hemorrhagic Fever

Discussion

A 35-year-old male presents to the hospital with a four-day history of high fever, severe headache, muscle pain, and fatigue. He also reports nausea and abdominal discomfort. Over the past 24 hours, he has developed nosebleeds, bleeding gums, and small bruises on his arms and legs. His symptoms began approximately a week after returning from a trip to a rural area where he had contact with livestock and local wildlife.

On examination, his temperature is 39.8°C (103.6°F), blood pressure is 95/60 mmHg, and his pulse is rapid. He appears ill, with conjunctival redness, mild jaundice, and petechial rashes on his chest. Laboratory tests show thrombocytopenia, elevated liver enzymes, and prolonged clotting times. His kidney function is mildly impaired, and his blood work reveals leukopenia. A PCR test confirms the presence of a viral hemorrhagic fever (VHF) pathogen.

He is admitted to an isolation unit and receives supportive care, including intravenous fluids, electrolyte correction, and monitoring for organ failure. Despite aggressive management, his condition worsens, requiring intensive care. Over the following days, with continued supportive treatment, his bleeding stabilizes, and he gradually recovers. He is discharged with instructions on long-term follow-up and infection control measures.

Questions
1. What is the most likely diagnosis in this patient?

a) Dengue fever

b) Viral hemorrhagic fever (VHF)

c) Leptospirosis

d) Meningococcemia

2. Which clinical finding is characteristic of viral hemorrhagic fevers?

a) Productive cough with hemoptysis

b) Petechiae, bleeding gums, and epistaxis

c) Ascites and jaundice

d) Severe joint pain with rash

3. What is the most important aspect of treatment for viral hemorrhagic fevers?

a) Broad-spectrum antibiotics

b) Antiviral therapy with immediate vaccination

c) Supportive care, including fluid resuscitation and organ support

d) High-dose corticosteroids

4. What laboratory finding is commonly associated with viral hemorrhagic fevers?

a) High platelet count

b) Normal liver enzymes

c) Thrombocytopenia and prolonged clotting times

d) Elevated white blood cell count

Reveal answers

Answers

1. Answer: b) Viral hemorrhagic fever (VHF)

The combination of fever, muscle pain, hemorrhagic symptoms (bleeding gums, petechiae), and recent travel history suggests a VHF. Other conditions like dengue and leptospirosis may present with fever and bleeding but lack the full spectrum of symptoms.

2. Answer: b) Petechiae, bleeding gums, and epistaxis

Hemorrhagic manifestations, including spontaneous bleeding from mucosal surfaces and skin, are hallmarks of VHFs. These occur due to platelet dysfunction and vascular injury caused by the virus.

3. Answer: c) Supportive care, including fluid resuscitation and organ support

There is no specific antiviral treatment for most VHFs. The mainstay of therapy is aggressive supportive care to prevent shock, organ failure, and excessive bleeding.

4. Answer: c) Thrombocytopenia and prolonged clotting times

VHFs typically cause low platelet counts and coagulation abnormalities, leading to an increased risk of spontaneous bleeding and organ dysfunction. Liver involvement may also contribute to clotting disturbances.