When Stroke Is Not a Stroke: A Case Report of Crimean-Congo Hemorrhagic Fever Presenting With Focal Neurological Deficits.

Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal tick-borne viral zoonosis with a wide geographic distribution, a significant case-fatality rate, and a risk of healthcare-associated transmission. Although CCHF commonly presents with nonspecific febrile illness followed by hemorrhagic manifestations, neurological symptoms may occur and can mimic acute stroke, creating diagnostic challenges in the emergency department. We report the case of a 72-year-old male farmer in the United Arab Emirates who presented with acute slurred speech, confusion, and right-sided facial droop, prompting stroke-code activation. Initial neuroimaging showed no acute intracranial hemorrhage, established infarction, or large-vessel occlusion. The patient subsequently developed worsening tachypnea, severe metabolic acidosis, thrombocytopenia, profound coagulopathy, mucocutaneous bleeding, acute kidney injury, and multiorgan failure. CCHF was confirmed by polymerase chain reaction testing. Despite maximal supportive care, including mechanical ventilation, vasopressor support, continuous renal replacement therapy, blood product transfusion, correction of coagulopathy, ribavirin therapy, and high-level isolation precautions, the patient developed refractory hemorrhagic shock and died later the same day. This case highlights CCHF as a rare but important stroke mimic. Emergency clinicians should consider CCHF in patients with acute neurological symptoms when accompanied by fever, bleeding manifestations, thrombocytopenia, coagulopathy, metabolic acidosis, renal dysfunction, shock, or relevant zoonotic exposure. Early epidemiological history, repeated clinical reassessment, prompt implementation of infection-control precautions, and multidisciplinary management are essential to reduce diagnostic delays and the risk of healthcare-associated transmission.