1st August 2023

A 38 year old woman attends A&E 5 days after returning from a holiday in Brazil.

A 38 year old woman attends A&E 5 days after returning from a holiday in Brazil. She had been enjoying the carnival festivities but also took part in 2 jungle hikes. She had all of her travel vaccinations and was diligent with malaria prophylaxis. She has a high temperature and complains of a rash and headache. On examination, you identify a blanching maculopapular rash. She is admitted for suspected dengue fever management. However, 4 days later, she became haemodynamically unstable with melaena and haematuria. She looks jaundiced, with evident hepatomegaly.

What has most likely occurred?

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