Infections associated with haemophagocytic syndrome: A case report of a rare coexistence with common infections

Infection-associated haemophagocytic syndrome (IAHS) is exceptional in typhoid and tuberculosis co-infections. We encountered a 50-year-old man with a history of pacemaker implantation who was previously treated for typhoid fever and currently presented with a chronic fever and shortness of breath. Initial laboratory tests revealed pancytopenia. A bone marrow aspiration was performed. However, due to cardiac problems, a bone marrow biopsy could not be performed. A bone marrow aspirate was submitted for cell block preparation. The cytology of the bone marrow aspirate revealed hemophagocytosis, which was initially presumed to be secondary to typhoid. Subsequently, cell block preparation of the bone marrow aspirate exhibited numerous granulomas with necrosis suggestive of tuberculosis. The patient was successfully treated with anti-tuberculosis drugs, steroids, and antibiotics. This case highlighted an association between IAHS and a common tropical illness. The usefulness of an aspirate cell block in the absence of biopsy and the potential existence of tuberculosis, especially in tuberculosis-endemic countries is to be noted.