Fever, Vomiting, Diarrhea and Subconjunctival Bleeding

An 18-year-old man presented with a 2-day history of fever, vomiting, and diarrhea. Three weeks before presentation, he had fallen into a canal. Physical exam was notable for the findings shown in the image. Laboratory studies showed acute kidney injury and elevations in aminotransferase and total bilirubin levels...

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