A previously healthy 18-year-old man presented to the emergency department with a 2-day history of fever, vomiting, and diarrhea. Three weeks before presentation, he had fallen into a canal.
His heart rate was 110 beats per minute, and the temperature was 38.4°C. The physical examination was notable for scleral icterus and subconjunctival hemorrhage in both eyes as well as mild abdominal tenderness without hepatosplenomegaly. Laboratory studies showed acute kidney injury and elevations in aminotransferase and total bilirubin levels.
What is the most likely diagnosis?
