Background: Crimean-Congo hemorrhagic fever is a sporadic zoonotic viral illness recently becoming endemic in regions in the western parts of India. It usually presents as a viral hemorrhagic fever with severe liver and kidney failure.
Case report: An 18-year-old male from the western part of Rajasthan presented with rapidly progressing areflexic weakness of limbs a week after brief fever. He deteriorated rapidly with drowsiness, fulminant liver failure, and acute kidney injury with high creatine kinase. He also developed thrombocytopenia and hemorrhage from various sites. Workup for viral hemorrhagic fever revealed IgM positivity for Crimean-Congo hemorrhagic fever. The patient kept worsening and died of multiorgan failure and diffuse alveolar bleeding after 14 days.
Conclusions: This report highlights the need to expand the differential diagnoses in the commonly encountered presentation of acute quadriparesis to include the possibility of tick-borne diseases like Crimean-Congo hemorrhagic fever in the setting of bleeding diathesis and acute hepatorenal syndrome.
Keywords: Acute fulminant hepatic failure; Crimean–Congo hemorrhagic fever; Guillain–Barre syndrome; acute kidney injury; ascending quadriparesis; tick paralysis.