A Catastrophic Presentation of Enteric Fever with Secondary Hemophagocytic Lymphohistiocytosis.

A 19 year old boy presented to the emergency room with fever of one week duration along with bleeding manifestations, few gastrointestinal symptoms, tachycardia, tachypnea and subtle encephalitic features. He was worked up for the usual causes of short duration fever, which proved inconclusive. In view of clinical worsening and cytopenias, a careful investigation process helped us in ruling out common etiologies for such a fever, alongwith unearthing the possibility of an underlying secondary hemophagocytic lymphohistiocytosis which led to severe thrombocytopenia and persistent high grade pyrexia. Widal test was positive in high titres, and patient was continued with antibiotics. Prompt treatment led to the uneventful recovery of the patient without any sequelae. Bleeding manifestations subsided, patient had rapid clinical improvement and was discharged after completing the course of antibiotics.