A vector borne, airborne and food borne infection with secondary hemophagocytic lymphohistocytosis: Case of triple infections in an immuno-competent patient

Pakistan is endemic to several bacterial, parasitic and viral infections including tuberculosis, malaria and dengue that account for a high rate of mortality each year. These different types of infections can occur through various routes of transmission and concurrently in individuals, especially in immunocompromised but rarely among immunocompetent. We report a case of a 25 year old immunocompetent female who was admitted with an initial diagnosis of dengue fever and diagnosed as having co-infection of COVID-19 and Brucella leading to secondary hemophagocytic lymphohistiocytosis (HLH). She was managed for all three infections and complications simultaneously.