Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome with high rates of mortality. Secondary HLH is acquired from an underlying illness and therefore difficult to diagnosis because the underlying disease can mask the symptoms of HLH or have a similar presentation. Therefore, it is important for physicians and health care providers to be familiar with HLH to keep in mind as a differential diagnosis in critically ill patients. It is imperative to start treatment early to decrease mortality. Case Report: We describe a case of a 42-year-old African-American man with a past medical history of human immunodeficiency virus (HIV), Hodgkin's lymphoma, and Epstein-Barr virus (EBV) who presented to the emergency department (ED) with diarrhea, nausea, and vomiting. He was ultimately diagnosed with acquired HLH. Early on during his admission he was treated with dexamethasone, but continued into multiple organ failure and succumbed on the 11th hospital day. Conclusion: Hemophagocytic lymphohistiocytosis is a rare disease and may not initially or come to mind at all as part of a differential diagnosis in critically ill patients.

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