Multiorgan Failure and Rhabdomyolysis in a Recetn émigré: Your Diagnosis?

21- year- old East In dian man, who had ar rived to Can ada one month ear lier, was brought to the emer gency room be cause of fe ver and rig ors. He had been well un til nine days pre vi ous, when he first noted fe ver, nau sea, vom it ing, oral ul cera tions and odynophagia. Over the next few days, his fe ver per sisted and he noted dark en ing of his urine and thigh pain on walk ing. Dur ing the two days be fore ad mis sion, his symp toms in ten si fied, and he be came con fused and le thar gic. The pa tient had had no pre vi ous health prob lems, was not on any medi ca tions and had no al ler gies. There was no his tory of al co hol, to bacco or il licit drug use. He de nied any re cent con tact with ani mals or any one with a feb rile ill ness. Hav ing ar rived from In dia only one month ear lier, the pa tient was un em ployed. Physi cal ex ami na tion re vealed a well de vel oped but di shev eled ill look ing young man. The pulse was 110 beats/min, blood pres sure was 140/100 mmHg, res pi ra tory rate was 20 breaths/min and the tem pera ture was 37.9°C orally. The mu cous mem branes were ex tremely dry, and there were ul cera tions of the buc cal mu cosa. There were no ab nor mali ties on car diac or res pi ra tory ex ami na tion. There was no ab domi nal ten der ness and no masses or or ganomegaly. Bowel sounds were nor mal, and the stool was posi tive for oc cult blood. He was ori ented to per son and time only. There was no men ing is mus. He was som no lent but rousable, and there were no fo cal neu ro logical signs. Com plete blood count re vealed a he mo glo bin of 116 g/L, a leu ko cyte count of 2000/µL and a plate let count of 32,000/µL.