Case 1 question
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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