Background <p>Acquired/secondary Hemophagocytic Lymphohistiocytosis (HLH) is a rare complication following enteric fever.</p> Case presentation <p>A 55-year-old lady from Bangladesh presented with deteriorating clinical symptoms (high-grade fever, diarrhoea, and abdominal pain) for about two weeks and was diagnosed with enteric fever by an immunochromatographic test for Salmonella. With a broad-spectrum antibiotic, her clinical condition did not improve with persistence of fever, diarrhoea, altered consciousness level, and ascites. Based on the clinical symptoms, the laboratory investigations, and an H-score of 208, a high probability of enteric fever-induced secondary HLH was suggested. Based on the revised HLH-2024 diagnostic criteria, the patient was diagnosed as a case of secondary HLH, and injectable Dexamethasone was commenced. Following the administration of Corticosteroids, the patient’s condition gradually improved.</p> Conclusion <p>In patients diagnosed with enteric fever, deteriorating clinical conditions despite getting antibiotics, physicians should consider secondary HLH as a differential diagnosis. Otherwise, diagnosis and management will be delayed, which can lead to morbidity and mortality.</p>