Concurrent Dengue, Tuberculosis Section and Secondary Haemophagocytic Lymphohistiocytosis in a Patient with Chronic Kidney Disease: A Case Report
The co-existence of multiple infections in an immunocompromised patient makes it challenging to make a diagnosis, especially when there are overlapping clinical features. The present case report describes a 65-year-old female with longstanding chronic kidney disease who presented with prolonged fever, progressive breathlessness, and right supraclavicular lymphadenopathy. Three of the four co-existing conditions were definitively diagnosed: dengue infection was confirmed by positive serum Non-Structural Protein 1 (NS1) antigen and dengue Immunoglobulin M (IgM), tuberculous lymphadenitis by Fine Needle Aspiration Cytology (FNAC) and secondary Haemophagocytic Lymphohistiocytosis (HLH) using the H-score and HLH-2024 diagnostic criteria. Community-acquired pneumonia was strongly suspected based on clinical and radiological findings. Cutaneous lesions over the anterior chest wall and upper back were consistent with scrofuloderma but were not histologically confirmed. The patient received multidisciplinary care, including Anti-Tubercular Therapy (ATT), broad-spectrum antibiotics, dexamethasone and Intravenous Immunoglobulin (IVIG) (for HLH), blood product transfusions and dialysis. The literature search identified reports of concurrent dengue and HLH, tuberculosis and HLH, and dengue with tuberculosis. However, there was no published case describing the simultaneous occurrence of dengue, tuberculosis, and secondary HLH in a single patient.