A Malevolent Mosquito

Author: Jessie Lynch / Editor: Sarah Edwards / Codes: IC7, IP2, SLO1 / Published: 02/09/2022

A 35-year-old previously fit and well male is brought in by ambulance at approximately 10pm.

He returned 10 days prior from a trip to Tanzania. He started feeling unwell 2 days prior to departure from Tanzania.  

He is complaining of pyrexia, diaphoresis, headaches, myalgia, abdominal pain, diarrhoea, and yellow discolouration of his skin.

On examination he is alert, tachycardic (HR 105), normotensive (BP 111/60) and tachypnoeic (RR32). SpO2 is 99% on FiO2 21%. He is apyrexic but did receive intravenous paracetamol prehospital.

Cardiorespiratory and neurological examination is unremarkable. He has obvious scleral icterus. His abdominal examination reveals diffuse tenderness but no peritonism, and palpable splenomegaly.

VBG: pH 7.31, HCO3- 20.0, pCO2 3.3, BE -4.1, lactate 7.1

Bloods:

• Urea 10.5
• Creatinine 174
• Total bilirubin 138.6
• ALT 57
• AST 86
• Platelets 25
• Hb 13.2
• CRP 259

CXR: Normal cardiomediastinal contour, lung fields clear.