RVF may also manifest itself as haemorrhagic fever in less than 1.0% of RVF cases. Two to four days after the onset of illness, the patient shows evidence of acute fulminant hepatitis with hepatic failure and hepatorenal syndrome, disseminated intravascular coagulation (DIC) and haemolytic anaemia with haemoglobin as low as 3gm/dL. The patient presents with haemorrhagic phenomenon as haematemesis, melaena, purpuric rash and bleeding gums. Jaundice was also reported but in low percentage of patients. Most patients with severe disease have elevated creatinine phosphokinase enzyme (CPK). Despite the marked elevation of liver enzymes (AST, ALT) more than triple fold, bilirubin level remains normal or slightly elevated and alkaline phosphatase (ALP) remain normal. Patients with haemorrhagic fever may remain viraemic for up to 10 days and case-fatality rate (CFR) is as high as 50.0%.