A 23-year-old male presented with pancytopaenia, transaminitis,  fever, severe vomiting and coughing. Examination revealed pyrexia,  tachycardia and left lower lobe pulmonary consolidation, and the tip of  the spleen was palpable. He was treated for CAP. Hepatosplenomegaly  without intra- or extrahepatic bile duct dilatation was found on  ultrasonography. A bone marrow biopsy was performed to investigate  the pancytopaenia and showed overt haemophagocytosis, which  prompted further investigation for HLH. He fulfilled six of the eight  criteria and was treated according to the HLH-94 protocol. At that time  a definitive trigger for HLH was not identified.
A month later, he developed marked neck stiffness with confusion  and a GCS of 13/15. Lumbar puncture results were suggestive of TB  meningitis, and TB treatment was initiated. Cultures later confirmed the  diagnosis of TB. He showed a full recovery and remained well until he  was lost to follow-up at 20 months when he relocated abroad.