A 22-year-old medical student comes to the urgent care clinic and reports a sudden onset of high fever, chills, severe headache, pain around the eyeballs and behind the eyes, muscle pain, bone pain, nausea and vomiting. She attends a medical school in the Caribbean Islands and is now visiting her family in the United States. On further questioning, she reports that her apartment building is surrounded by many mud pits infested with Aedes mosquitoes and she had many mosquito bites over the last few weeks. One of her classmates got ‘breakbone fever’ last week. On examination, she has a faint, generalized macular rash that looks like ‘islands of white in a sea of red’. Laboratory tests demonstrated thrombocytopenia, monocytosis, elevated albumin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. A PCR test confirmed the diagnosis. When she was told that she was infected with a virus that belongs to the flaviviridae family, she rightly worried about the possibility of a hemorrhagic fever. What is the most likely diagnosis in this patient?
