Secondary Hemophagocytic Lymphohistiocytosis In Typhoid Fever: Case Report

Abstract

Background: In poor countries, typhoid fever is a major cause of fever. The illness can vary in severity from an uncomplicated febrile illness to sepsis and complications like hemophagocytic lymphohistiocytosis (HLH), which affects multiple organs. A delay in diagnosis is frequently the biggest obstacle to a good outcome due to the rarity of this syndrome. Case: A 38-year-old male was admitted with complaints of persistent intermittent fever for three weeks. Other complaints were maculopapular rashes, epistaxis, black-colored stools, abdominal pain, nausea, vomiting, fatigue, and decreased appetite. He was transferred to our hospital due to progressive clinical deterioration. On physical examination, he was pale, with a temperature was 39.5C, a dry tongue with petechial spots at the root of the tongue, and some maculopapular rash of the entire body. There was splenomegaly. Laboratory investigations showed pancytopenia. IgM salmonella typhi was positive. A liver function test revealed transaminitis. Additional laboratory tests showed hypertriglyceridemia, hyperferritinemia and hyponatremia. USG’s abdomen showed splenomegaly. Patient possibility of secondary HLH was considered and investigated accordingly. He was given packed red blood cells, platelets transfusion, and a high dose of methylprednisolone orally. He showed dramatic improvement, complete blood count (CBC) normalized on day 7 with complete recovery on follow-up. Conclusion: We report a hemophagocytic lymphohistiocytosis in typhoid fever with persistent intermittent fever. Based on our case, early diagnosis and prompt treatment are critical to a successful patient’s recovery.