Hemophagocytic Lymphohistiocytosis Secondary to Miliary Tuberculosis in a Resource-Limited Setting: A Case Report

Hemophagocytic lymphohistiocytosis is a rare life-threatening condition, with a high mortality rate, characterized by a dysfunctional immune response resulting in multi-organ damage. The secondary or sporadic form of the disease can be triggered by a multitude of infections, malignancies, and autoimmune disorders. Tuberculosis is commonly involved as a trigger for hemophagocytic lymphohistiocytosis. In a rare case, a 52-year-old gentleman with advanced human immunodeficiency virus (HIV) and disseminated tuberculosis (TB) developed secondary hemophagocytic lymphohistiocytosis. This patient was successfully treated with the 1994 hemophagocytic lymphohistiocytosis treatment protocol at a hospital in a rural province in South Africa. TB, a treatable condition, remains the most lethal disease in South Africa. This case highlights another severe complication of TB. Despite the widespread rollout of antiretroviral treatment, HIV still remains South Africa's largest epidemic. This case emphasizes the need for physicians, treating people living with HIV infection and TB, to have a high index of suspicion in the appropriate clinical situation for hemophagocytic lymphohistiocytosis. Improved outcomes are possible for these cases when diagnosed and treated timely and correctly.