Soru

Following a recent hiking trip in Nantucket, Massachusetts, a $48$-year-old male is brought to the urgent care clinic by his spouse due to three days of high fevers, drenching sweats, and noticeably dark urine. The patient recently completed a two-week course of oral doxycycline for an expanding, ring-like rash on his right calf. Today, his temperature is $39.4^{\circ}\text{C}$ ($102.9^{\circ}\text{F}$), heart rate is $115/\text{min}$, and blood pressure is $112/68\text{ mmHg}$. Physical examination is notable for yellowing of the sclerae and mild left upper quadrant abdominal tenderness with a palpable spleen edge.

Laboratory analysis reveals:
Hemoglobin: $8.8\text{ g/dL}$
Platelets: $92,000/\text{mm}^3$
Leukocytes: $7,200/\text{mm}^3$
Total bilirubin: $3.6\text{ mg/dL}$
Indirect bilirubin: $3.0\text{ mg/dL}$
Lactate dehydrogenase: $780\text{ U/L}$
Prothrombin time (PT): $12\text{ s}$ (normal: $11-13\text{ s}$)
Activated partial thromboplastin time (aPTT): $26\text{ s}$ (normal: $25-35\text{ s}$)

Which of the following is the most likely diagnosis?