Crimean–Congo haemorrhagic fever presenting as thrombotic microangiopathy and acute renal failure

1Department of Nephrology, Dialysis and Transplantation and 2Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, 3Department of Cell Biology, University of Alabama at Birmingham and Children's Hospital Birmingham, Alabama, USA and 4Pasteur Institute, Tehran, Iran Crimean–Congo haemorrhagic fever (CCHF), also known as Asian Ebola, is a fatal viral disease that is rapidly increasing worldwide [1,2]. CCHF is a tick-borne viral infection characterized by liver dysfunction, ecchymosis, extensive bleeding with shock and disseminated intravascular coagulation [3–5]. The causative agent of CCHF is the virus of genus Nairovirus and family Bunyaviridae [3–6]. The virus is transmitted to humans primarily by the bite of an infected tick of the genus Hyalomma or by direct contact with blood or secretions of an infected animal or person [3–5]. The virus is currently widely disseminated in the Russian Federation, the Balkans, the Middle East, Central Asia and Africa [3,6,7]. Small animals and birds can spread infected ticks around the world [5]. It is said that ∼5 billion birds (potential tick-harbourers) fly annually from Europe to Africa, and only approximately one-half return [8]. This demonstrates how infected ticks could be transported from the East to the West. The mortality rate after infection ranges from 10 to 80% in humans [3,6]. It has been postulated that renal failure, disseminated intravascular coagulation and persistent fever are associated with higher mortality rates [7]. We report a case of CCHF that presented with symptoms suggestive for thrombotic microangiopathy and acute renal failure, and rapidly succumbed to death following extensive haemorrhages.