NYMC Faculty Publications

Unusual Presentation of Complicated Relapsing Fever With Spontaneous Hemoperitoneum Mimicking Surgical Acute Abdomen: A Case Report

Author Type(s)

Faculty

DOI

10.1186/s12245-025-01035-7

Journal Title

International Journal of Emergency Medicine

Document Type

Article

Publication Date

12-1-2025

Department

Emergency Medicine

Keywords

Acute abdomen, Case report, Hemoperitoneum, Relapsing fever, Unusual presentation

Disciplines

Medicine and Health Sciences

Abstract

Background: Louse-borne relapsing fever (LBRF) is a prevalent disease in Ethiopia, affecting malnourished and impoverished populations. Historically fatal, mortality has decreased to less than 5% with antibiotics. Symptoms include high fever, rigors, myalgia, hepatosplenomegaly, jaundice, and petechial rash. Diagnosis is challenging due to Giemsa-stained blood films and PCR in resource-limited settings. Case Presentation: A 29-year-old Ethiopian patient experienced abdominal pain, vomiting, diarrhea, and high fever for 3 days. Physical examination revealed low blood pressure, oxygen saturation, tachycardia, decreased air entry, and a tender abdomen. A bedside ultrasound revealed bilateral pleural collection, dense B lines, an air bronchogram, and abdominal collection. The patient had thrombocytopenia, leukocytosis, acute kidney injury, elevated transaminase levels, and Borrelia spirochetes in her blood. The patient recovered fully within 8 days after respiratory failure. Discussion: This case highlights the importance of recognizing relapsing fever (RF) as a critical mimic of surgical abdomen, preventing unnecessary surgical interventions in hemorrhagic abdominal emergencies. Conclusion: A life-threatening Borrelia-induced hemoperitoneum in Ethiopia was successfully managed, despite complications of surgical acute abdomen with hemoperitoneum, severe thrombocytopenia, and multiorgan involvement, highlighting the importance of infectious consideration in acute abdomen.

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