Crimean-Congo Hemorrhagic Fever Without Hemorrhagic Manifestations: A Case Report

Abstract

Background: Crimean-Congo hemorrhagic fever (CCHF) is a potentially life-threatening viral infection caused by Crimean-Congo hemorrhagic fever virus (CCHFV). The virus is primarily transmitted through the bite of infected Hyalomma ticks or through contact with the blood or tissues of infected animals, particularly during slaughter. Human-to-human transmission may also occur following exposure to the blood or other body fluids of infected individuals. Although severe CCHF may be associated with hemorrhagic manifestations, disseminated intravascular coagulation, multiorgan failure, and death, overt bleeding is not an obligatory feature of the disease. Case Presentation: A 32-year-old man presented with a 2-day history of high-grade fever, photophobia, and neck pain associated with watery diarrhea. He worked in a city abattoir with regular occupational exposure to sheep and cattle and had not traveled outside the United Arab Emirates during the preceding year. On examination, he was hemodynamically stable and had a maculopapular rash over the trunk. His Glasgow Coma Scale score was 15/15. There was no neck rigidity, lymphadenopathy, jaundice, or clinical evidence of bleeding. Initial laboratory investigations revealed leukopenia, marked thrombocytopenia, and mildly elevated liver transaminases. His platelet count continued to decline during hospitalization. Given the epidemiological exposure and the combination of acute febrile illness and progressive thrombocytopenia, CCHF was suspected. Both CCHF serology and reverse-transcription polymerase chain reaction (RT-PCR) were positive, confirming the diagnosis. The patient received supportive treatment and oral ribavirin. His clinical condition and hematological parameters subsequently improved, and he was discharged in stable condition without developing hemorrhagic manifestations. Conclusion: CCHF should be considered in patients presenting with an acute febrile illness and thrombocytopenia, particularly when there is a history of occupational exposure to livestock or potential exposure to infected ticks. The absence of overt hemorrhage does not exclude the diagnosis. Early recognition, laboratory confirmation, appropriate infection-control measures, and timely supportive management are essential for optimizing outcomes and reducing the risk of secondary transmission.