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<p>Enteric fever, caused by <i>Salmonella enterica</i> serovars <i>typhi</i> and <i>paratyphi</i>, remains highly prevalent in low- and middle-income countries, particularly across South Asia. While most cases respond to appropriate antimicrobial therapy, rare but life-threatening complications such as hemophagocytic lymphohistiocytosis (HLH) may occur. In endemic settings, HLH is frequently under-recognized owing to substantial clinical overlap with severe or complicated enteric fever, resulting in delayed diagnosis and increased mortality. We describe four adult patients with HLH secondary to culture-proven enteric fever, all presenting with persistent fever, gastrointestinal symptoms, cytopenias, hepatosplenomegaly, hyperferritinemia, hypertriglyceridemia, and transaminitis. HLH was diagnosed using the HLH-2004 criteria and confirmed on bone marrow examination. <i>Salmonella typhi</i> was isolated in three cases and <i>S. paratyphi A</i> in one. All patients received culture-directed antibiotics, with early intravenous dexamethasone added when hyperinflammation persisted, and all achieved complete clinical and laboratory recovery. As both were administered concurrently, the independent contribution of corticosteroids to recovery could not be established.</p>

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Secondary Hemophagocytic Lymphohistiocytosis Triggered by Enteric Fever: A Case Series from a Resource-Limited Setting

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Pyrus Bhellum,
  • Satyendra Khichar,
  • Mahendra Dhaka,
  • Rajat Goyal,
  • Abhishek Purohit,
  • Deepak Kumar

摘要

Enteric fever, caused by Salmonella enterica serovars typhi and paratyphi, remains highly prevalent in low- and middle-income countries, particularly across South Asia. While most cases respond to appropriate antimicrobial therapy, rare but life-threatening complications such as hemophagocytic lymphohistiocytosis (HLH) may occur. In endemic settings, HLH is frequently under-recognized owing to substantial clinical overlap with severe or complicated enteric fever, resulting in delayed diagnosis and increased mortality. We describe four adult patients with HLH secondary to culture-proven enteric fever, all presenting with persistent fever, gastrointestinal symptoms, cytopenias, hepatosplenomegaly, hyperferritinemia, hypertriglyceridemia, and transaminitis. HLH was diagnosed using the HLH-2004 criteria and confirmed on bone marrow examination. Salmonella typhi was isolated in three cases and S. paratyphi A in one. All patients received culture-directed antibiotics, with early intravenous dexamethasone added when hyperinflammation persisted, and all achieved complete clinical and laboratory recovery. As both were administered concurrently, the independent contribution of corticosteroids to recovery could not be established.