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#idboardreview 25 M return from Venezuela 8d ago & 6d of F, HA, jaundice, N, V, 6 lb wtloss, dark urine. During travel walked barefoot in mud, hiked, swam, used mosquito repellent, no pre-travel medical advice. AST 14k, ALT 8k, Cr9, AP 250, Plt80, Bil7, diagnosis? #medEd #idmedEd
Viral hemorrhagic fever #YellowFever hallmarks include pathognomonic triad of hemorrhagic fever w/ jaundice & renal disease. Other viral hemorrhagic fevers may present w/ either jaundice or w/renal disease but combo suggests YF w/ appropriate exposure to mosquitoes
Mild cases of #yellowfever cannot be distinguished clinically from falciparum malaria, leptospirosis, viral hepatitis, typhoid, rickettsial disease, hepatotoxin ingestion, or relapsing fever.
DDx YF: Dengue +capillary leakage, rash at some point but Hepatitis occurs only occasionally & is mild. Renal involvement does not occur w/ dengue & significant proteinuria should always suggest yellow fever over dengue even early in the course of the clinical evolution
DDx YF: Rift Valley fever, like YF is highly hepatotropic & may have renal dysfunction. Severe cases w/ hemorrhagic manifestations <1% of all cases. RVF predominates in livestock raising areas of Africa, which do not overlap much w/ forested areas where YF occurs
Ddx YF: Fulminant hepatitis B: although proteinuria & renal disease are not usually as severe or common during the earlier stages of disease. Appropriate hepatitis B markers should be obtained
