An Uncommon Presentation of Typhoid Fever - HLH

Abstract

Typhoid fever has an estimated worldwide prevalence of 12-33 million cases with high incidence in India, especially urban centres. Hemophagocytic lymphohistiocytosis is a rare complication of typhoid fever, which may be fatal, if untreated. We describe the case of a young male, with a history of travel from Mumbai, who presented to our tertiary care centre with high grade fever, body pain, slurring of speech and loose stools. Investigations showed bicytopenia, hyperferritinemia, hypertriglyceridemia and bone marrow biopsy revealed erythrophagocytic histiocytes and granulomas. Blood culture grew Salmonella typhi. After ruling out other possibilities, including underlying immunodeficiency conditions, the diagnosis of HLH was made as per the HLH 2004 diagnostic criteria. The patient responded to culture sensitive antibiotics, steroids and supportive care. We discuss this case to create awareness about an uncommon complication of a common disease such as typhoid fever.