Case Report
Volume: 4 | Issue: 2 | Published: Feb 19, 2020 | Pages: 75 - 78 | DOI: 10.24911/ejmcr/173-1574044842
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
Article Info
Authors
Wong Ji Yin
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Poh Kok Wei
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Wong Poh Shean
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Nik Hafidzah
Pathology Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Sharifah Suryani
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Cheah Chee Ken
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Ng Tiang Koi
Medical Department, Hospital Tuanku Ja'afar Seremban, Malaysia
Publication History
Received: November 18, 2019
Revised: January 12, 2020
Accepted: February 08, 2020
Published: February 19, 2020
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, green
