Uncommon presentation of a common tropical infection

Ray, Ujjwayini; Dutta, Soma; Bandyopadhyay, Syamasis; Mondal, Susovan

doi:10.4103/ijpm.ijpm_306_18

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Ray et al also described two patients with HLH secondary to typhoid fever. One of these recovered with antibiotics alone, while the other required steroids in addition to antibiotics [ 15 ]. George et al (2018) also described a case of typhoid fever complicated by HLH that recovered with antibiotics alone [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Secondary Hemophagocytic Lymphohistiocytosis Due to Typhoid Fever

Shekhar¹,

Radhakrishnan²,

Nagar³

2023

Cureus

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Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper-inflammatory state that is caused by a highly activated but ineffective immune system. It can be primary or secondary to triggers like infections, malignancies, and autoimmune conditions. The authors present the case of a young male with a fever and abdominal pain due to typhoid. He continued to have a high-spiking fever and developed dyspnea, requiring oxygen therapy despite being treated with appropriate antibiotics. Laboratory evaluation revealed cytopenias and deranged liver function tests, and abdominal imaging revealed hepatosplenomegaly. These clinical and laboratory findings raised suspicion of HLH secondary to typhoid fever. Further investigations were suggestive of hyperferritinemia and hypofibrinogenemia, and bone marrow aspirates showed hemophagocytes. The patient was treated with immunosuppression (dexamethasone) and antibiotics and showed remarkable recovery. Hemophagocytic lymphohistiocytosis should be suspected in patients with tropical infections like enteric fever, tuberculosis, malaria, dengue, etc. that worsen despite appropriate treatment, as late diagnosis is associated with greater mortality.

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Section: Discussionmentioning

confidence: 99%

Secondary Hemophagocytic Lymphohistiocytosis Due to Typhoid Fever

Shekhar¹,

Radhakrishnan²,

Nagar³

2023

Cureus

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Unusual Presentations of the Usual Typhoid Fever

Doke,

Diwan,

Makashir

et al. 2024

Infect Dis Clin Pract

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Background More than half of the global burden of typhoid fever occurred in India in 2017. [1] The incidence of this disease remains high in India as per a study done in 2023. [1] This is due to poor access to safe water and sanitation as well as inadequate vaccination coverage across the country. Typhoid fever can affect multiple organs. Methods We have presented 6 patients with atypical presentations seen between February 2020 to June 2022. Results There were 3 males and 3 female patients. The youngest patient was 20 years and the oldest was 56 years old. Diagnosis of salmonellosis was based on cultures. Conclusions All patients made a complete recovery, and were stable at the time of discharge.

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Hemophagocytic lymphohistiocytosis following enteric fever: A rare autopsy case report

Fernandes,

Mhashete,

Patwardhan

2023

Indian Journal of Pathology and Microbiology

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Hemophagocytic lymphohistiocytosis (HLH) is a severe and frequently underdiagnosed disorder of systemic immune dysregulation resulting in hypercytokinemia and histologically evident hemophagocytosis, We report a case of a 34-year-old man who presented with breathlessness, generalized weakness, and fever of unknown origin with pancytopenia. Clinically the patient was admitted for febrile illness, and treated symptomatically but his general condition worsened leading to death within 21 hours of admission. A complete autopsy was performed. The deceased had a significant past history of repeated episodes of fever, weight loss, and axillary lymphadenopathy over a period of 8 months with multiple hospital admissions. He was also diagnosed with enteric fever (Widal test and Typhi IgM positive) at the start of these episodes. Hemogram during this period revealed persistent pancytopenia. Serum ferritin, serum triglycerides, and liver function tests were consistently deranged. Investigations for the etiology of fever and blood cultures were negative while the bone marrow aspirate revealed a normocellular marrow. CT abdomen-pelvis showed mild hepatomegaly with enlarged retroperitoneal lymph nodes. Infective endocarditis, lymphoma, and bronchopneumonia were being considered the clinical diagnoses. The significant autopsy findings were hepatosplenomegaly with retroperitoneal lymphadenopathy and multiple gastric ulcers. On microscopy, the liver, spleen, bone marrow, and lymph nodes showed characteristic hemophagocytosis. Post-mortem histopathological examination clinched the diagnosis of HLH and fulfilled six out of eight diagnostic criteria of the HLH-2004 protocol. We discuss the clinical course and diagnosis of this unique case and strive to create awareness about secondary HLH induced by common diseases, such as enteric fever.

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Uncommon presentation of a common tropical infection

Cited by 4 publications

References 7 publications

Secondary Hemophagocytic Lymphohistiocytosis Due to Typhoid Fever

Secondary Hemophagocytic Lymphohistiocytosis Due to Typhoid Fever

Unusual Presentations of the Usual Typhoid Fever

Hemophagocytic lymphohistiocytosis following enteric fever: A rare autopsy case report

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