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, es-pecially during the covid-19 pandemic. during the covid-19 pandemic, diagnostic delays may occur in the manage-ment of cchf, particularly due to resource allocation.