A rare case of complicated typhoid fever presenting with secondary Hemophagocytic Lymphohistiocytosis

Enteric fever is one of the important causes of tropical fever with a prevalence of 11-21 million cases worldwide annually. It encompasses both typhoid and paratyphoid fever. Salmonella enterica Typhi is the causative organism for typhoid fever, manifesting as an uncomplicated febrile illness to life-threatening sepsis with multiorgan dysfunction. It is complicated by neuropsychiatric manifestation (2%-40%), gastrointestinal bleeding (10%), and intestinal perforation (1%-3%). Hemophagocytic Lymphohistiocytosis (HLH) is a rare complication of typhoid fever. Herein we report the case of a 24-year-old male from North-Eastern India, presenting with spikes of fever, altered behavior, a generalized rash, haematochezia, and hemophagocytes on bone marrow examination due to hemophagocytic lymphohistiocytosis secondary to complicated typhoid fever.