Case of the Month - June 2010

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An HIV-negative, 38y old woman staying on a farm near Ficksburg in the eastern Free State presented to the emergency room in Cape Town confused, complaining of a loss of vision and a rash for 1 week. She had been seen by a local practitioner 2 days previously, who had started her on oral doxycycline and referred her to the eye clinic. No other history was available. Ophthalmology review found normal vision and no evidence of retinopathy or uveitis. She had a low grade fever, multiple lesions on the breast (figure 1) and 2 similar lesions on her back, with a maculopapular rash on her trunk, abdomen and limbs, involving the palms but not soles. There was no lymphadenopathy or organomegaly, she was disorientated in time, place and person, but had no cranial or peripheral nerve lesions.
 

Her platelet count was 140 x 109/L, but the rest of her full blood count, liver function and renal function tests were normal. Lumbar puncture revealed:

Polymorphs	Lymphocytes	Red blood cells	Protein	Glucose	Gram stain	AFB stain
17	42	4	0.58	2.7	Negative	Negative

During the consultation, an anguished telephone call was received from relatives on the farm in Ficksburg asking if her illness could be related to the outbreak of Rift Valley Fever in farms around where she was staying.

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