3rd August 2023

A 37-year-old Royal-Air-Force Officer returns from a recent service deployment in Asia with a high-grade fever and is admitted to the Acute Medicine Unit

A 37-year-old Royal-Air-Force Officer returns from a recent service deployment in Asia with a high-grade fever and is admitted to the Acute Medicine Unit 7 days later. He complains of fever, headache, and cough. On examination, you note flat, erythematous macules and a diffuse purpuric rash with an eschar bite.

His observations are RR 28, BP 86/47, and HR 122. His capillary refill time is sluggish at 4 seconds. 3 blood cultures are negative.

Blood tests show elevated creatinine, urea, and neutrophils. Liver function tests are very deranged. Platelets are low. Chest X-Ray shows bilateral infiltrations.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.