Secondary Hemophagocytic Lymphohistiocytosis Due to Typhoid Fever.

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper-inflammatory state that is caused by a highly activated but ineffective immune system. It can be primary or secondary to triggers like infections, malignancies, and autoimmune conditions. The authors present the case of a young male with a fever and abdominal pain due to typhoid. He continued to have a high-spiking fever and developed dyspnea, requiring oxygen therapy despite being treated with appropriate antibiotics. Laboratory evaluation revealed cytopenias and deranged liver function tests, and abdominal imaging revealed hepatosplenomegaly. These clinical and laboratory findings raised suspicion of HLH secondary to typhoid fever. Further investigations were suggestive of hyperferritinemia and hypofibrinogenemia, and bone marrow aspirates showed hemophagocytes. The patient was treated with immunosuppression (dexamethasone) and antibiotics and showed remarkable recovery. Hemophagocytic lymphohistiocytosis should be suspected in patients with tropical infections like enteric fever, tuberculosis, malaria, dengue, etc. that worsen despite appropriate treatment, as late diagnosis is associated with greater mortality.

Abdominal Pain Followed by Altered Mental Status: A Rare Presentation of Guillain Barré Syndrome.

Guillain Barré syndrome (GBS) is an acute inflammatory polyneuropathy with several variants; it usually presents as acute symmetrical muscle weakness with or without bulbar involvement, making it a neurological emergency. In this report, we describe the case of a 39-year-old male who presented with abdominal pain for three days and whose illness became progressively drowsy on the fifth day. Based on clinical assessment, nerve conduction studies, and biochemical, microbiological, and radiological investigations, other causes were ruled out and it was concluded that the patient had hyponatremia secondary to syndrome of inappropriate diuretic hormone secretion (SIADH) due to GBS. Although sensory symptoms like pain or dysaesthesias occurring in the back or extremities are common and may precede motor weakness, abdominal pain remains a very rare presentation of GBS. GBS is usually understood as a "pure" peripheral nervous system disorder but central nervous system (CNS) dysfunction may occur due to metabolic abnormalities (like hyponatremia and CO2 narcosis) or autonomic dysfunction in GBS, its treatment, or due to GBS itself (Anti-GQ1b disease variant).