Haemophagocytic lymphohistiocytosis complicating typhoid fever: A case report from Senegal.

We report a case of secondary haemophagocytic lymphohistiocytosis (HLH) triggered by confirmed typhoid fever (Salmonella Typhi) in a 23-year-old Senegalese man. The initial radiological presentation suggested ileo-caecal tuberculosis. Thus, persistent fever, marked hyperferritinaemia and systemic inflammation raised suspicion of HLH, confirmed by bone marrow examination demonstrating hemophagocytosis. The H-Score was 206, corresponding to 88-93% probability. Blood cultures isolated ciprofloxacin-susceptible Salmonella Typhi. Fluoroquinolone monotherapy led to complete clinical and biological remission without the need for immunosuppression. This case underscores the importance of including typhoid fever in the differential aetiology of HLH in endemic settings, and of early H-Score calculation to expedite diagnosis.