EJMCR. 2020; 4(2): 75-78

Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report

Authors: Wong Ji Yin, Poh Kok Wei, Wong Poh Shean, Nik Hafidzah, Sharifah Suryani, Cheah Chee Ken, Ng Tiang Koi.

ABSTRACT

Background: Dengue fever classically presents with fever, arthralgia, myalgia, leukopenia, and thrombocytopenia. A classical presentation with a positive serology test is usually enough to make the diagnosis in an endemic area. Case Presentation: A 30-year-old man presented with fever, leucopenia, thrombocytopenia, hepatitis, and delirium. Dengue Immunoglobulin M (IgM) serology was positive. Blood culture grew Salmonella typhi, his ferritin was raised, and bone marrow histology showed histiocytes and hemophagocytic activity. A 2-week course of ceftriaxone (60-75 mg/kg/day) and intravenous immunoglobulin (0.4 g/kg once a day) for 3 days resulted in complete resolution of his illness. Conclusion: We report a case of typhoid fever with hemophagocytic lymphohistiocytosis mimicking as dengue fever due to cytopenias and hepatitis, and dengue IgM serology was positive. Although rare, a high index of suspicion is required for early diagnosis and treatment.

Keywords:
Dengue fever, typhoid, hemophagocytic lymphohistiocytosis, HLH, case report


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Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report


Authors
Wong Ji Yin
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Poh Kok Wei
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Wong Poh Shean
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Nik Hafidzah
Pathology Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Sharifah Suryani
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Cheah Chee Ken
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Ng Tiang Koi
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
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Correspondence to:
. Poh Kok Wei, Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia.; dr.teddypoh@gmail.com

Publication history
Received 18 Nov 2019
Revised 12 Jan 2020
Accepted 08 Feb 2020
Published online 19 Feb 2020
Published in print 12 Mar 2020

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Pubmed Style

Yin WJ, Wei PK, Shean WP, Hafidzah N, Suryani S, Ken CC, Koi NT. Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. EJMCR. 2020; 4(2): 75-78. doi:10.24911/ejmcr/173-1574044842


Web Style

Yin WJ, Wei PK, Shean WP, Hafidzah N, Suryani S, Ken CC, Koi NT. Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. https://www.ejmcr.com/?mno=74101 [Access: March 30, 2020]. doi:10.24911/ejmcr/173-1574044842


AMA (American Medical Association) Style

Yin WJ, Wei PK, Shean WP, Hafidzah N, Suryani S, Ken CC, Koi NT. Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. EJMCR. 2020; 4(2): 75-78. doi:10.24911/ejmcr/173-1574044842


Vancouver/ICMJE Style

Yin WJ, Wei PK, Shean WP, Hafidzah N, Suryani S, Ken CC, Koi NT. Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. EJMCR. (2020), [cited March 30, 2020]; 4(2): 75-78. doi:10.24911/ejmcr/173-1574044842


Harvard Style

Yin, W. J., Wei, . P. K., Shean, . W. P., Hafidzah, . N., Suryani, . S., Ken, . C. C. & Koi, . N. T. (2020) Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. EJMCR, 4 (2), 75-78. doi:10.24911/ejmcr/173-1574044842


Turabian Style

Yin, Wong Ji, Poh Kok Wei, Wong Poh Shean, Nik Hafidzah, Sharifah Suryani, Cheah Chee Ken, and Ng Tiang Koi. 2020. Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. European Journal of Medical Case Reports, 4 (2), 75-78. doi:10.24911/ejmcr/173-1574044842


Chicago Style

Yin, Wong Ji, Poh Kok Wei, Wong Poh Shean, Nik Hafidzah, Sharifah Suryani, Cheah Chee Ken, and Ng Tiang Koi. "Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report." European Journal of Medical Case Reports 4 (2020), 75-78. doi:10.24911/ejmcr/173-1574044842


MLA (The Modern Language Association) Style

Yin, Wong Ji, Poh Kok Wei, Wong Poh Shean, Nik Hafidzah, Sharifah Suryani, Cheah Chee Ken, and Ng Tiang Koi. "Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report." European Journal of Medical Case Reports 4.2 (2020), 75-78. Print. doi:10.24911/ejmcr/173-1574044842


APA (American Psychological Association) Style

Yin, W. J., Wei, . P. K., Shean, . W. P., Hafidzah, . N., Suryani, . S., Ken, . C. C. & Koi, . N. T. (2020) Typhoid fever with hemophagocytic lymphohistiocytosis masquerading as dengue fever: a case report. European Journal of Medical Case Reports, 4 (2), 75-78. doi:10.24911/ejmcr/173-1574044842


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