The differential diagnosis included leptospirosis, a palindromic rheumatism with systemic involvement or severe bacterial sepsis with a meningitic process. Admission investigations revealed a WBC count of 12.7 × 103/mL (Neutrophils 80% Lymphocytes 16%) and c-reactive protein (CRP) of 327 U/L (Normal < 5 U/L). Blood picture showed toxic granules in polymorphonuclear leukocytes together with a left shift suggesting a bacterial infection. Urinalysis on admission showed 2+ proteinuria with occasional leukocytes and red blood cells. Serum creatinine was 229 μmol/L (normal 45-90 micromol/L), aspartate transaminase (AST) 92 U/L(normal 0 – 35 U/L), alanine transaminase (ALT) 45 U/L (normal 0 – 35 U/L), bilirubin 95 μmol/L (normal 5.0–17.0 μmol/L), Direct 40 μmol/l. Serum alkaline phosphatase was 255 U/L(normal 50-100 U/L), her ESR was 72 mm/1sthr, and anti-nuclear antibodies and rheumatoid factor were negative. Urine culture was negative, and the blood culture were negative.