A 33-year-old man living in Cayenne, French Guiana, was admitted in the Bichat hospital in Paris with a 3-week history of fever associated with dyspnea and confusion. A chest X-ray previously made in French Guiana showed an alveolar infiltrate of the middle lobe. Amoxicillin and then doxycycline were administered, but did not alleviate the symptoms. Physical examination revealed a loss of 4 kilograms in the last month, confusion, hypotension (98/63 mmHg), tachycardia (126 beats per minute), a red but painless left eye, congestive heart failure, fine crackles in the right lung field, and a one-centimetre-wide left axillary node.
Haematological blood tests revealed a haemoglobin level of 137 g/l with signs of haemolysis (elevated lactic dehydrogenase, low haptoglobin), a total white blood cell count of 11.1×109/L (69% granulocytes, 21% lymphocytes), and thrombocytosis (392×109/L platelets). The blood film showed stigmata of mononucleosis syndrome. Blood chemistry revealed hyponatremia, mild hepatitis, pancreatitis, and elevated cardiac markers. Table 1 summarizes biological data.
Electrocardiogram showed sinus tachycardia. Transthoracic echocardiography revealed an altered left ventricular ejection fraction (35% estimation with Simpson's method), global hypokinesia, but no signs of endocarditis. Abdominal computed tomography (CT) scanner was normal.