Haemophagocytic lymphohistiocytosis

A two-year-old boy from a district hospital was admitted to Parami General Hospital with a febrile illness. He presented with high fever, diarrhoea, mucocutaneous manifestations, and high inflammatory markers. Initially he was diagnosed as Multisystem Inflammatory Syndrome in Children (MIS-C) and treated accordingly. Although intra- venous immunoglobulin and corticosteroid were given, he did not respond to the treatment and developed splenomegaly. Further evaluation and bone marrow aspiration revealed haemophagocytosis and he was finally diagnosed as Haemophagocytic Lympho- histiocytosis (HLH). Then he was subsequently treated according to HLH protocol and responded well. This report highlights the diagnostic complexities and therapeutic challenges in distinguishing MIS-C from HLH, emphasizing the importance of early identification and tailored treatment for hyper-inflammatory syndromes in paediatric patients.