The patient was a 47-year-old woman from Belgium who vacationed in Gambia. She did not receive a yellow fever vaccine because Gambia did not require it of travelers. On the sixth day after arriving in Gambia, she became acutely ill with high fever, chills, headache, back and muscle pain. She returned to Belgium where she entered the hospital with jaundice, severe asthenia (weakness), and anuria. She had no neurological symptoms or bleeding. Her platelet count was low at 95,000/mm3, a BUN of 151 mg/dL, total bilirubin of 3.5 mg/dL, and she had a greatly elevated aspartate aminotransferase (AST) of 49,000 U/L. Hemodialysis was initiated.
Yellow fever was diagnosed by a positive RT-PCR. She began bleeding from injection sites and her bowel. She developed hypovolemic shock. The patient was intubated and placed on ventilation. She received four units of fresh frozen plasma, four units of platelets, and two units of albumin, but remained in a coma with hypothermia and no change in her hypovolemic shock. She died seven days after admission to the hospital in Belgium.
Yellow fever vaccination is attenuated but considered very safe. Even if a country does not require the vaccine, travelers to Africa and South America should be vaccinated before travel.
