A Case Of Murine Typhus Presenting With Hemophagocytic Lymphohistiocytosis

Murine typhus, also known as endemic typhus, is a rickettsial illness transmitted by the flea Xenopsylla cheopis, usually in contact with rats. Symptoms of the illness can be nonspecific, and murine typhus has been considered an underrecognized entity as it is sometimes confused with viral illnesses. Although hemophagocytic lymphohistiocytosis (HLH), a rare inflammatory condition characterized by activation of macrophages and phagocytosis of hematopoietic cells in the bone marrow, liver, and spleen, has been reported to occur in other rickettsial illnesses, to our knowledge it has not been reported as a complication of murine typhus. We report the case of a 39-year-old man for whom murine typhus was diagnosed with serological evaluation and HLH was diagnosed via bone marrow biopsy and other studies. Although HLH has been previously described with scrub typhus, and iron overload has been described with murine typhus infection, our case represents the first report of HLH diagnosed concurrently with a murine typhus infection.