Leptospirosis Complicated by Secondary Hemophagocytic Lymphohistiocytosis in a Child: A Rare Association

REPORTper 24-hour dietary recall before onset of illness, but her appetite was somewhat reduced for the last 15 days.On examination, she was alert and cooperative.Her body weight and height were measured as 20 kg (3rd-10th centile) and 121 cm (10th-25th centile), respectively.Her body temperature was 102F with normal blood pressure, pulse rate and volume, and capillary refill time.There was mild jaundice, hepatomegaly (liver palpable 3 cm below the right costal margin), and splenomegaly (tip palpable).She had ascites, bilateral pitting pedal edema, and right-sided pleural effusion.Immediate treatment was started with fluid, broad-spectrum antibiotics (ceftriaxone), and other supportive measures after sending samples for relevant investigations.Her urine volume improved after fluid bolus.She was transfused with 10 mL/kg of packed red blood count (RBC) in view of severe anemia.The initial laboratory studies showed anemia, reduced leukocyte, and platelet counts without any abnormal cells on peripheral smear.She had hypoglycemia, hypoalbuminemia, hyperbilirubinemia,