CHENNAI: A 17-year-old student has recovered after enteric fever triggered secondary haemophagocytic lymphohistiocytosis (HLH), which progressed to disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS) and multi-organ dysfunction at Apollo Speciality Hospitals, Teynampet here.

The teenager was admitted with high-grade fever, vomiting, loose stools, nasal bleeding and breathlessness.

Despite treatment for enteric fever, his condition worsened, with falling haemoglobin, white blood cells and platelets, deteriorating kidney and liver function, and markedly elevated ferritin and inflammatory markers.

The persistent fever, falling blood counts and inflammation prompted evaluation for secondary HLH. Bone marrow examination showed haemophagocytic activity, supporting the diagnosis of enteric fever-associated secondary HLH.

His condition progressed to DIC, followed by kidney and liver dysfunction. He developed ARDS and required mechanical ventilation.

A multidisciplinary team involving internal medicine, critical care, pulmonary medicine, haemato-oncology and infectious diseases treated the infection and hyperinflammatory response with intravenous antibiotics, corticosteroids, blood-product support and intensive care. “The bone marrow findings supported the diagnosis, enabling the team to address both the underlying infection and the associated hyperinflammatory response,” a doctor from Internal Medicine said. “Secondary HLH can be difficult to identify as its early features may resemble severe infection or sepsis.”

Harshad Reddy, director–group oncology and international business, Apollo Hospitals, said that the case highlighted the importance of early recognition and close coordination between specialities.

The patient improved, was weaned off the ventilator and shifted to the ward for physiotherapy and supportive care. He has since been discharged, stable, breathing independently and ambulatory, with follow-up advised.