Disseminated tuberculosis presenting with secondary hemophagocytic lymphohistiocytosis in an adult woman

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome caused by uncontrolled immune activation and cytokine storm. Secondary HLH is frequently triggered by infections, malignancies, or autoimmune conditions; tuberculosis is an uncommon but increasingly recognized cause, particularly in endemic regions. We report a 33-year-old South Asian woman who presented with severe respiratory failure, pancytopenia, and systemic hyperinflammation. Microbiological and histopathological evaluation confirmed disseminated tuberculosis complicated by secondary HLH. Early initiation of antitubercular therapy combined with corticosteroids resulted in clinical improvement. This case underscores the importance of maintaining a high index of suspicion for HLH in patients with disseminated tuberculosis presenting with cytopenias and hyperinflammation, where prompt diagnosis and treatment are critical to reducing mortality.