Fever, mucocutaneous haemorrhage, and severe headache during an epidemic of haemorrhagic fever.

Accepted 21 January 1998 A 36-year-old man developed moderate-grade fever, headache, and malaise. On the third day, he noticed purpuric skin lesions and sought medical opinion. Investigations revealed a platelet count of 57 x 109/l and haematocrit of 64%. Several people in his locality and the city had similar illness with reported deaths. A diagnosis was made and he was treated with antipyretics for the next 3 days when he developed epistaxis, intense headache, and drowsiness. Cranial computed tomography (CT) (figures 1 and 2) was done and he was referred to this hospital for further management. On admission he had active epistaxis and complained of persistent headache. History of head trauma in any form was denied. He had no history of any coexisting medical illness. He was febrile, drowsy but oriented, and co-operative. His blood pressure was 130/75 mmHg. He had left-sided hemiparesis (grade 4/5 power) with brisk reflexes. There were no signs of meningeal irritation. Systemic examination did not reveal any abnormality. Laboratory investigations revealed a haemoglobin level of 8.9 g/dl, total leucocyte count was 7.9 x109/l with a normal differential count, haematocrit 57% and platelet count 70 x 1i0/l. Blood biochemical parameters and chest X-ray were normal. He was treated with an infusion of platelet-rich plqsma, and acetazolamide and mannitol to reduce cerebral oedema. Over the next 4 days, he became afebrile with a rise in platelet count to 130 x109/l. However, his neurological status deteriorated with increasing drowsiness, increase in left hemiparesis and bilateral extensor plantar response. A repeat cranial CT scan was not significantly different from the earlier one. In view of his neurological deterioration, he was subjected to a definitive procedure following which he steadily improved. Six months later he was doing well.