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

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

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

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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.

Key words: Dengue fever, typhoid, hemophagocytic lymphohistiocytosis, HLH, case report

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