A 27-year-old male returns from a two-week solo hiking trip in a remote forested region of Central India. Five days after returning, he presents with fever, generalized fatigue, and gum bleeding. He also reports dark-colored urine and mild breathlessness. No previous history of bleeding disorders.
On examination:
- Temp: 101.6°F (38.6°C)
- Pulse: 110 bpm
- BP: 90/60 mmHg
- Conjunctival pallor
- Petechial rash on lower limbs
- Mild splenomegaly
Investigations:
- Hb: 7.8 g/dL
- Platelets: 18,000/mm³
- WBC: 3,500/mm³
- Reticulocyte count: Elevated
- LDH: High
- Peripheral smear: Schistocytes
- Coombs test: Negative
- Renal and liver function: Mildly deranged
- Dengue, malaria, leptospira, and scrub typhus serologies: Negative
- What is your differential diagnosis for this patient with fever, bleeding, and hemolysis?
- What does the presence of schistocytes suggest?