A Rare Initial Presentation in Extra Pulmonary Tuberculosis- Hemophagocytic Lymphohistiocytosis as a Differential Diagnosis

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder characterized by excessive activation of the immune system leading to tissue damage and organ dysfunction. We present case HLH Like initial presentation secondary extrapulmonary tuberculosis (TB) in young male who presented with fever, constitutional symptoms generalized lymphadenopathy. Initial this there were no much evidence suggest tuberculosis, but few months later he lymphocytic exudative pleural effusion high Adenosine Deaminase (ADA) level patient improved antituberculosis treatment(ATT). are some features favouring not fulfilling required criteria for diagnosis based on our Sri Lankan setting, can be considered as most probable differential while discussing others. This emphasizes importance degree suspicion underlying etiology Pyrexia Unknown Origin (PUO) atypical clinical findings inflammatory response.