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
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
Authors
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
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
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: April 24, 2024]. doi:
10.24911/ejmcr/173-1574044842
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
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 April 24, 2024]; 4(2): 75-78. doi:
10.24911/ejmcr/173-1574044842
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
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
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
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
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