Case history
Case history
A 40-year-old male is admitted to hospital with a 3-day history of fever, severe headache, myalgia, arthralgia, and fatigue. The patient is a cattle farmer and denies sick contacts or illness among his household livestock. He recalls several mosquito bites prior to the onset of symptoms. He notes a loss of appetite and possibly some weight loss over the last 10 days. A Giemsa-stained blood film is negative for Plasmodium species. Further blood samples are sent for reverse transcriptase-polymerase chain reaction and IgM enzyme-linked immunosorbent assay testing. After admission, he develops nausea and vomiting, with mild upper abdominal pain. Physical examination reveals yellow sclera and a slightly enlarged liver and spleen. He has joint tenderness and swelling. He has a low-grade fever (38°C) and hypotension (70/50 mmHg) but no tachycardia. The following day he develops mild subconjunctival haemorrhage but shows no other signs of bleeding. He also becomes increasingly confused and develops blurred vision, although his neurological examination is otherwise normal. Twenty-four hours later, his delirium and abdominal pain resolve. His scleral icterus disappears after 2 to 3 days; however, the anorexia and blurred vision persist for almost a week. He makes a full recovery and is discharged after 1 week in hospital.
Other presentations
In contrast with the influenza-like illness seen in African outbreaks, gastroenteritis-like illness (nausea, vomiting, abdominal pain, and diarrhoea) was the most common clinical presentation of RVF during the 2000 outbreak in Saudi Arabia.
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