Immunosuppressive therapy was initiated immediately after bone marrow studies. Methylprednisoslone (30 mg/ kg/day 9 3 days) followed by IVIG (1 gm/kg/day 9 2days) were used initially. HLH protocol was held in abeyance in the event of relapse of cytopenia or persistent fever. The patient was also exhibited anti-tubercular therapy consiting of isoniazid, rifampin, ethambutol and pyrazinamide. With the above treatment the patient responded rapidly; respiratory distress resolved within 24-48 h with resolution of radiological findings on follow-up X-ray chest. High grade fever settled within 24 h, organomegaly resolved over 7-10 days. Cytopenias also resolved over 4-5 days as did biological markers of Haemophagocytic Syndrome. The child was discharged on the 16th day of methylprednisolone and is on regular follow-up with no recurrence of symptoms and normal blood counts.