The patient was a 2-year-old female with an unremarkable past, perinatal or family history. She was admitted with fever and diarrhoea of 2 days duration. She was managed with broad spectrum antibiotics, hydration and other supportive measures. High grade fever persisted along with progressive hepatosplenomegaly; on the 10th day of admission she developed ascites, respiratory distress and bilateral ptosis. Chest X-ray revealed bilateral pulmonary infiltrates suggestive of Acute respiratory distress syndrome. Peripheral blood counts revealed anaemia (7.6 gm/dl) and thrombocytopenia (87 9 10 3 /ll). Leucopenia (total leucocyte count 2.4 9 10 3 /ll, absolute neutrophil count 1.1 9 10 3 /ll) developed 4-5 days later. The coagulation profile was deranged with prolonged PT (32 s, INR 3.02) and APTT (39 s) in the absence of overt bleeding. D-dimer was positive. Serum triglycerides were 457 mg/dl, serum ferritin was 1,331 ng/ml and LDH was 1,889 IU/l. Bone marrow aspiration and biopsy revealed prominence of macrophages and histiocytes and phagocytosis of mature myeloid and lymphoid elements (Fig. 1 ). In addition, ELISA (IgM) for M tuberculosis was unequivocally positive at 1.08 U/ml (normal \ 0.90 U/ml) while IgG (0.18 U/ml, normal \ 0.90) and IgA (45.53 U/ml, normal \ 300) were negative, suggestive of acute Tubercular infection. Mantoux test was negative; tests for HBV, HCV and HIV were negative.