Fatal Crimean-Congo Hemorrhagic Fever with an Atypical Clinical Course during the COVID-19 Pandemic.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a viral zoonotic disease characterized by high fever, bleeding manifestations, and a high mortality rate. Most patients begin to experience bleeding 5 to 7 days after the onset of the illness, usually while hospitalized. This report highlights that even though patients may develop shock and multi-organ failure, there might be no visible signs of bleeding until shortly before death. Methods: This case report describes a 42-year-old male patient with a confirmed diagnosis of CCHF via RT-PCR, who died despite intensive care treatment. Despite receiving intensive care treatment, he did not respond to the septic shock therapy and unfortunately passed away within a few hours. The diagnosis of the disease was made by the reference laboratory with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test for CCHF. Results: In this case, the patient exhibited no visible signs of bleeding, such as hematemesis, melena, or gross hematuria, despite being in shock. While CCHF mortality (5-30%) typically occurs during the 3-5-day hemorrhagic phase, this patient died suddenly due to massive intra-abdominal bleeding, skipping the typical bleeding phase. Conclusion: Clinicians should consider that individual differences may be seen in the clinical course of CCHF disease. In addition, the Coronavirus Disease-2019 (COVID-19) pandemic was experienced worldwide when the patient applied. Given the overlapping initial symptoms of COVID-19 and CCHF, clinicians should prioritize differential diagnosis, especially during the COVID-19 pandemic. During the COVID-19 pandemic, diagnostic delays may occur in the management of CCHF, particularly due to resource allocation.