Here is a patient's story I am seeking help for....
30 year old businessman presented with fever high grade for 5-6 days. abdominal pain poorly localised, of 1 day duration, severe since few hours, bodyache and weakness. Examination at admission, revealed tachycardia, icteric tinge. Abdomen was tender (diffuse), but no guarding, bowel sounds were normal. chest showed few bilateral crepts . CBC : Hb Normal, TLC 5300, Platelets: 65000/dL. S Bil 3 mg/dl, SGPT:3500 SGOT 2900 T Proteins and albumin: Normal. HAV, HBsAg, HCV, HEV Negative. ANA Negative. INR 1.7 X abd: Normal. USG abd: altered echotexture of liver, ascites and pleural effusion. Next day, patient complained breathlessness. CXR: bilateral lower lobe consolidation. As abdominal tenderness was unexplained, CT abdomen+angio :did not show any hepatic venous involvement. Biliary system was normal. There was ascites, and bilateral lower lobe consolidation (pneumonia). Though his creat was normal, urine showed albumin 4+. Cultures are awaited. Patient's condition deteriorated rapidly with requirement of mechanical ventilation.
Other historical information: non-alcoholic, No prior drug intake (aspirin, NSAID etc).
Epidemiological data: area is experiencing swine flue outbreak with few deaths due to respiratory illness. H1N1 screening is negative for the patient.
What are the DD: