Hemophagocytic Lymphohistiocytosis Induced Cytokine Storm Secondary to Human Immunodeficiency Virus Associated Miliary Tuberculosis

Hemophagocytic lymphohistiocytosis (HLH) is a rarely diagnosed fatal inflammatory disease associated with an overactive immune system. It occurs in a host of conditions, with human immunodeficiency virus (HIV) being a rare but serious cause, usually occurring in patients with acquired immunodeficiency syndrome (AIDS). The diagnosis of HLH can be very difficult, as it presents with vague signs and symptoms, which can be present in multiple diseases. This case highlights the diagnostic dilemma faced when treating this potentially fatal condition. Usually, treating the underlying trigger for HLH is sufficient to counteract the overwhelming inflammatory response; however, this can prove to be difficult, as demonstrated in our patient. We present a case of miliary tuberculosis in the setting of HIV/AIDS, complicated by HLH in a young male patient. Whether it was due to delays in treatment or the rapidly fulminant nature of the disease, our patient had a poor clinical outcome. Although rare, tuberculosis-associated HLH must be considered as a cause of secondary HLH in all patients, especially those who are immunosuppressed.