5th July 2024

A 53-year-old gentleman who does not have any significant past medical history is admitted with a low grade fever

A 53-year-old gentleman who does not have any significant past medical history is admitted with a low grade fever and watery diarrhoea for the last 2 days. He was on holiday in Indonesia 7 days ago. His wife also has diarrhoea. Investigations are as follows:

Hb 86 g/L (115-165), WBC 12.7×10⁹/L (4-11), Neutrophils 9.8×10⁹/L (2-8), Platelets 85×10⁹/L (150-400), CRP 130 mg/L (<5), Na-136 mmol/L (135-145), K 4.0 mmol/L (3.5-5), Urea 10 mmol/L (2.5-7.5), Creatinine 340 μmol/L (60-110), Bilirubin 30 μmol/L (<21), ALT 60 U/L (<41), ALP 190 U/L (30-130). Coagulation Screen: PT 20s (10-14), APTT 45s (24-37), Fibrinogen 1.4 g/L (1.5-4.5), D-dimer 700 ng/ml (<500).

Blood films showed fragmented RBCs, increased reticulocyte count and thrombocytopenia. Coombs’ test is negative. What is the most likely diagnosis in this case?

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