Back from Bali with fever and myalgia

By Dr Lito Papanicolas, pathology registrar, microbiology.

She has just returned from Bali. On examination she appears miserable and a maculopapular rash is visible on her extremities.

The GP orders E/LFTs, FBC and a malaria screen. Results show: leukopenia; WCC 2.13 x109/L (4.00–11.0), thrombocytopenia; platelets 62 x109/L (150–450) and LFTs show moderately elevated transaminases.

Blood film shows rouleaux formation, leukopenia and reactive lymphocytes. No malarial parasites