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A 35 years old butcher (Mashhad Resident) was reffered from a private clinic to infectious ward of Imam Reza Hospital. He had a fever, starting 5 days ago, with myalgia, headache, astenia and two times vomiting and eventually abdominal discomfort, chillness and drowsyness were appeared. * He gave a history of epistaxis, hematuria, abdominal tenderness and diarrhea from 8days ago. In spite of lacking of signs and symptoms of ICP, he was stupored, and disoriented. He was hospitalized in another hospital. Lab tests in that hospital were: WBC= 4000, with 60% neutrophilia, CRP ++, ESR in first hour = 45 cm, 8-10 RBC in urine hpf, a moderate proteinuria, a high liver enzymopathy, OT=300, PT= 400, total bil. 1.2 mg/dl, chest X.Ray only congestion of lungs, PT and PTT normal, platelate = 90000, Hep B, and Hep C tests were negative. For existence of purpura and petechial lesions and thrombocytopenia with diagnosis of ITP prednisolon was initiated. EKG and electrolyte in the third day were normal. The patient was discharged and from a private clinic was reffered to the infectious ward. Blood culture, urine culture, gasometric and electrolyte detection, LFT, kidneys function, urine volume, coagulation tests, CBC (Hj), EKG were performed and prednisolon discontinued. Purpura, petechia, on the chest and abdomen and epistaxis and rectorrhagia exist. In the second hospital day, fever was 38.2 with heartbeat about 50/min, blood pressure 95/60, two units blood were transfused and after that Ringer lactate was infused. Liver was palpated 3 cm under the border of ribs. Spleen was palpable, CBC, platelate count, PT, PTT, LFT, LDH, Ret.count, creatinine, blood sugar, Na, K, Ca, C3, C4, protein electerophoresis were requested and on the next day, laboratory reports were: WBC= 2900, with 50% neutrophylia, platelate = 90000, PT= 15 seconds, PTT= 45 seconds, anti HCV, and HBS Ag= negative, blood culture negative, CBC with a shift to the left, Hg 9.5 gr/lit, MCV, MCH under the normal limit. Third generation of cephalosporine initiated, heart beat with sinusal rhytym and 50 beats/min. Febrile agglutination tests requested. The patient was alert, blood smears for malaria and borrelia were negative. Nose- bleeding and rectorrhagia continued. Whole blood transfused and platelate was requested. On the third hospital day in spile of discontinuing of bleeding the patient was ill with generalized myalgia. Blood pressure was 110/75, temperature 37.4, platelate count 110000, WBC= 4500, serum creatinine one milligram. On the forth hospital day, patientʹs situation was better, petechiae and purpura were fading, platelate count and coagulation factors were requested. On the 5th hospital day, injectable antibiotic switched to oral route and patient was discharged.