Unusual presentation of complicated
relapsing fever with spontaneous
hemoperitoneum mimicking surgical acute
abdomen: a case report

Unusual presentation of complicated
relapsing fever with spontaneous
hemoperitoneum mimicking surgical acute
abdomen: a case report

Unusual presentation, Relapsing fever, Hemoperitoneum, Acute abdomen, Case report

Abstract
Background: Louse-borne relapsing fever (LBRF) is a prevalent disease in Ethiopia, affecting malnourished and
impoverished populations. Historically fatal, mortality has decreased to less than 5% with antibiotics. Symptoms
include high fever, rigors, myalgia, hepatosplenomegaly, jaundice, and petechial rash. Diagnosis is challenging due to
Giemsa-stained blood films and PCR in resource-limited settings.
Case Presentation: A 29-year-old Ethiopian patient experienced abdominal pain, vomiting, diarrhea, and high fever
for 3 days. Physical examination revealed low blood pressure, oxygen saturation, tachycardia, decreased air entry, and
a tender abdomen. A bedside ultrasound revealed bilateral pleural collection, dense B lines, an air bronchogram, and
abdominal collection. The patient had thrombocytopenia, leukocytosis, acute kidney injury, elevated transaminase
levels, and Borrelia spirochetes in her blood. The patient recovered fully within 8 days after respiratory failure.
Discussion: This case highlights the importance of recognizing relapsing fever (RF) as a critical mimic of surgical
abdomen, preventing unnecessary surgical interventions in hemorrhagic abdominal emergencies.
Conclusion: A life-threatening Borrelia-induced hemoperitoneum in Ethiopia was successfully managed, despite
complications of surgical acute abdomen with hemoperitoneum, severe thrombocytopenia, and multiorgan
involvement, highlighting the importance of infectious consideration in acute abdomen.
Keywords Unusual presentation, Relapsing fever, Hemoperitoneum, Acute abdomen, Case report

Yemane Gebremedhin Tesfay1*, Habtamu Kebede Adera2

, Zelalem Getahun Demissie3

, Dirijit Mamo Alemu1
,

Menbeu Sultan Mohammed1,3, Getaw Worku Hassen4

and Mohammed Kalifa Nuguse1

https://doi.org/10.1186/s12245-025-01035-7

2025

Peri Irawan

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