Severe Tropical Infections

A 26-year-old female patient presented with high-grade fever for 10 days followed by pedal edema and decreased urine output for 4 days. She developed shortness of breath for last 2 days which was associated with dry cough. There was no history of paroxysmal nocturnal dyspnea and orthopnea. History of epistaxis was present for 1 day. No history of travel to another place was present. On examination, she was conscious, well oriented. Her pulse rate was 124/min, blood pressure was 90/60 mmHg and SpO (2) was 86% on room air. Eschar was present under the left breast. On auscultation, bilateral crepitations were present. Cardiovascular examination revealed no abnormality. Blood Investigations revealed hemoglobin—9.0 mg/dl, platelet count—70,000/mm (3) , blood urea—108 mg/dl, serum creatinine—1.6 mg/dl, blood sugar—91 mg/dl, SGOT/PT—440/235. X-ray chest was suggestive of bilateral diffuse alveolar shadows. Arterial blood gas analysis revealed pH—7.38, pO (2) —58 mmHg, pCO (2) —44 mmHg, HCO (3) —15 mmol/L, SaO (2) —86%.