Fulminant Hemophagocytic Lymphohistiocytosis Secondary to Miliary Tuberculosis: A Fatal Case Report

Hemophagocytic lymphohistiocytosis (HLH) is a hyper-inflammatory syndrome driven by uncontrolled immune activation. Although Epstein–Barr virus is the prototypical infectious trigger, disseminated tuberculosis (TB) is an increasingly recognised cause, especially in endemic regions. We describe a 49-year-old woman who presented with miliary TB complicated by secondary HLH and rapidly progressive multiorgan dysfunction. Despite prompt anti-tubercular therapy (ATT) and HLH-directed immunosuppression, she died within 48 hours of intensive-care admission. The case underlines the need for early marrow evaluation and simultaneous initiation of ATT and HLH-specific therapy when TB-HLH is suspected.