Triple trouble--macrophage activation syndrome in a case of severe leptospirosis and scrub typhus co-infection.

Macrophage activation syndrome is a potentially life threatening phenomenon characterised by aggressive proliferation of macrophages and T lymphocytes leading to haemophagocytosis of other blood cells and multi organ failure. Here we present a very unusual combination of leptospirosis and scrub typhus infection leading to macrophage activation syndrome. Scrub typhus associated with macrophage activation syndrome has rarely been reported in India. A 40 year old female presented with high grade fever, seizures, bodyache, arthralgia and severe breathlessness. Investigations revealed persistent thrombocytopenia, impaired liver function tests, renal dysfunction, leptospiral IgM ELISA positive and a positive Weil Felix test. There was evidence of haemophagocytosis in bone marrow. Macrophage activation syndrome if left untreated has been associated with rapidly fatal outcome and early treatment can help us save that one precious thing..called life..!