Fever of Unknown Origin in a Renal Transplant Recipient

A syndrome of exaggerated lymphocytic proliferation and activation, called hemophagocytic lymphohistiocytosis (HLH) can occur primarily due to genetic mutation, in children and secondary to infection, malignancy or autoimmunity in adults. It is characterized by a misdirected activation of immune system, which causes cytokine release from macrophages and cytotoxic cells, in an uncontrolled fashion. Most treatment protocols are formulated for primary hemophagocytic histiocytosis, which occurs in children, whereas awareness and therapeutic guidelines for the secondary form of the disease which affects predominantly the adults is limited. We present a 29 year old renal transplant recipient presenting with fever of unknown origin found to have HLH secondary to tuberculosis, who responded to anti-tuberculous treatment.