Crimean-Congo haemorrhagic fever presenting with acute compartment syndrome of the extremities (think beyond normal infections)

Abstract

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonosis transmitted to humans and animals (which act as a reservoir) through the bite of a 'Hyalomma' tick. CCHF virus belongs to the genus Nairovirus Humans are infected when they come in direct contact with the blood or secretions of infected livestock or other infected humans. This disease initially presents with non-specific febrile symptoms common to many viral illnesses and later progresses to disseminated intravascular coagulation (DIC) with haemorrhagic manifestations.We present the case of a middle-aged man with CCHF. He presented to the hospital with DIC and acute compartment syndrome in the right forearm, requiring urgent orthopaedic intervention. The diagnosis was delayed because there was no clear history of contact. The patient was started taking ribavirin on the fifth day of hospital admission. He recovered fully.

Keywords: infectious diseases; surgery.

Figure 1

Ultrasound of the arm showing diffuse subcutaneous oedema of the right arm with a small subcutaneous collection along the medial aspect of the proximal part of the right arm (measuring 10.7×6.3 mm).

Figure 2

The patient had multiple fasciotomies done. The wound was exposed, the haematoma was evacuated, the soft tissue was debrided and the bleeding was cauterised.

Figure 3

The skin was partially closed, leaving the central part of the arm fasciotomy wound open to avoid closure under tension. A compression dressing and back slab were applied.