Introduction Budd-Chiari syndrome is a rare disease characterized by hepatic venous flow obstruction. The obstruction may be thrombotic or non-thrombotic anywhere along the venous course from the hepatic venules to the inferior vena cava (IVC) junction to the right atrium. In clinical practice, cases can be misdiagnosed, particularly in regions where resources are limited, unless the clinician pays special attention to such diagnosis. Case report and clinical discussion Here, we would like to present a misdiagnosed case of Budd Chiari syndrome. This reported case is a case of 30 years old female patient complaining of dull abdominal pain and swelling. Initially, the patient consulted a local health facility where the patient was diagnosed with tuberculous peritonitis and subsequently treated with an anti-TB regimen empirically. Within a few days of taking medicine, she developed mild jaundice and lower limb edema. At this stage, the patient came to us, which after taking history, her physical examination unveiled mild jaundice, ascites, abdominal tenderness, and mild lower limb petting edema. The patient was recommended an abdominal CT scan with contrast, which revealed early enhancement and enlargement of the caudate lobe and non-opacification of hepatic veins with narrowing of the hepatic part of the inferior vena cava consistent with Budd-Chiari syndrome. The patient was started on warfarin and referred for a hepatic decongestive procedure. After four months of performing a transjugular portosystemic shunt, the patient came to us for follow-up. She had an excellent clinical improvement and was started on rivaroxaban 20 mg daily orally. Conclusion The main takeaway lesson of this particular case is to consider the differential diagnosis of ascites from an etiologic point of view and not to overemphasize a single etiology.

Objective Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease associated with a high fatality rate. CCHF is endemic in Afghanistan, and its morbidity and mortality have increased recently but there is limited data about the characteristics of fatal cases. We aimed to report the clinical and epidemiological features of fatal CCHF cases who were admitted to Kabul Referral Infectious Diseases (Antani) Hospital. Methods This is a retrospective cross-sectional study. The demographic and presenting clinical and laboratory features of 30 fatal CCHF cases diagnosed by reverse transcription polymerase chain reaction (RT-PCR) or enzyme-linked immunosorbent assay (ELISA) tests were collected from the patients’ records between March 2021 and March 2023. Results During the study period, a total of 118 laboratory-confirmed CCHF patients were admitted to Kabul Antani Hospital of whom 30 patients (25 males, 5 females) consequently died, indicating a 25.4% case fatality rate (CFR). The age of the fatal cases ranged from 15 to 62 years and their mean age was 36.6 ± 11.7 years. Concerning occupation, the patients were butchers (23.3%), animal dealers (20%), shepherds (16.6%), housewives (16.6%), farmers (10%), student (3.3%), and others (10%). The clinical symptoms of the patients on admission were fever (100%), generalized body pain (100%), fatigue (90%), bleeding (any type) (86.6%), headache (80%), nausea/vomiting (73.3%), and diarrhea (70%). The initial abnormal laboratory findings were leukopenia (80%), leukocytosis (6.6%), anemia (73.3%), and thrombocytopenia (100%), raised hepatic enzymes (ALT & AST) (96.6%) and prolonged prothrombin time/international normalized ratio (PT/INR) (100%). Conclusion The hemorrhagic manifestations associated with low platelet and raised PT/INR levels are linked with fatal outcomes. A high index of clinical suspicion is required to recognize the disease at an early stage and to begin the treatment promptly for reducing mortality.