男，45岁，农民。发热5天，呕吐腹泻伴少尿 1天，查体:神志清楚，结膜充血，双腋下可见“搔抓样” 出血点。实验室检査:WBC 25 x 109/L,PIt 30 x 109/L, ALT 80 U/L,TBil 45 pmoL,尿蛋白（+ + + )。最可能 的诊断是

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