Case Report Hemophagocytic Lymphohistiocytosis Complicating Dengue and Plasmodium vivax Coinfection Muhammad Khurram, Muhammad Faheem, Muhammad Umar, Asif Yasin, Wajeeha Qayyum, Amna Ashraf, Javeria Zahid Khan, Ali Hasnain Yasir, Yusra Ansari, Muhammad Asad, Iram Khan, Shuja Abbas, Irum Rasheed, Natasha Rasool, and Hamama Tul Bushra Khar Rawalpindi Medical College, Holy Family Hospital, Rawalpindi 46300, Pakistan Correspondence should be addressed to Muhammad Khurram; drmkhurram@gmail.com Received 6 June 2015; Revised 26 July 2015; Accepted 5 August 2015 Academic Editor: Christian Urban Copyright © 2015 Muhammad Khurram et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder. Dysfunction of cytotoxic T and natural killer (NK) cells causes uncontrolled activity of lymphocytes and histiocytes which leads to HLH. Infections, malignancies, and autoimmune disorders are associated with development of HLH. Dengue and Plasmodium vivax are rare causes of HLH. We report the frst ever case ofa young man who developed fatal HLH that complicated Dengue Hemorrhagic Fever (DHF) and Plasmodium vivax infection. 1. Introduction Hemophagocytic lymphohistiocytosis (HLH) is a rare dis- order which can be familial or acquired. Acquired HLH complicates a number of viral, bacterial, and parasitic infec- tions. It is also associated with autoimmune disorders and certain malignancies like T cell lymphoma. Familial HLH has autosomal recessive transmission and is seen in infants less than 18 months old. HLH is associated with high mortality [1]. HLH results from dysfunction of cytotoxic T and natural killer (NK) cells that cause uncontrolled lymphocytes and histiocytes activity which is associated with phagocytosis of hematopoietic cells [2]. HLH is characterized by prolonged fever and sepsis-like syndrome. It presents with nonspecifc clinical features like fever and hepatosplenomegaly. Laboratory fndings include cytopenias, raised serum aminotransferase levels, hypofb- rinogenemia, hypertriglyceridemia, hyperferritinemia, and increased lactic dehydrogenase (LDH) levels. Dengue and malaria are important but rare causes of HLH [3, 4]. We report the frst ever case of 19-year-old male with HLH diagnosed in settings of both Dengue Hemorrhagic Fever (DHF) and Plasmodium vivax (P. vivax) malaria infections. 2. Case Report A 19-year-old, previously healthy, motor mechanic was admitted with 13-day history of high grade fever, headache, retroorbital pain, and myalgias. One day before admission he became restless and irritable. On examination his pulse was 104/minute, temperature 101 ∘ F, respiratory rate 24/minute, and blood pressure 110/70 mmHg (pulse pressure 40 mmHg). He was jaundiced. Abdominal examination revealed tender hepatomegaly with liver span of 18 cm. Chest examination was suggestive of right sided mild to moderate pleural efu- sion. He was noted to be drowsy, disoriented, and confused. His Glasgow Coma Scale (GCS) was 12/15 (E3, M5, and V4). No focal neurological defcit or signs of meningeal irritation were noted. Te rest of the clinical examination was unremarkable. Ultrasonographic examination at admission showed thick walled gall bladder (wall thickness 13 mm), hep- atomegaly (17 cm), splenomegaly (13.6 cm), mild to moderate ascites, and mild to moderate pleural efusion. CT scan brain without contrast showed brain edema. Respiratory alkalosis was noted on arterial blood gas (ABG) analysis. ECG was Hindawi Publishing Corporation Case Reports in Medicine Volume 2015, Article ID 696842, 4 pages http://dx.doi.org/10.1155/2015/696842