The case described could well have been familial HLH, especially in view of age of onset. However, absence of a history of consanguinity, demonstration of recent mycobacterial infection and prompt response to treatment suggest infection associated HLH. The patient presented with prolonged fever complicated by organomegaly, cytopenias and ARDS, was investigated and treated promptly with good response to treatment. In a study of HLH in children a median age of onset of 17.4 months was described with average duration of fever ranging from 6 to 14 days. Our patient had onset at 24 months of age with fever duration of 10 days before developing symptoms. The patient was diagnosed and treated early at the 11th day of admission as against a median of 19 days described in Western literature [12] . Haemophagocytic syndrome related to childhood tuberculosis has been reported previously, in this patient the diagnosis remained presumptive based on the ELISA, positive family history and rapidity of response to ATT and immunosuppression [10] .