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How to approach and manage palpitations in clinical practicePalpitations are a common and often anxiety-provoking symptom for people who present in primary care. While many cases are benign, some indicate significant cardiac arrhythmia with potential haemodynamic compromise, highlighting the need for structured evaluation and timely intervention. This review provides health professionals with a practical, evidence-informed framework for the assessment, investigation and management of patients presenting with palpitations, integrating current guidance from the National Institute for Health and Care Excellence and the European Society of Cardiology.
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Dilemma of finding the most useful QTc formula: a retrospective analysis of south-east LondonBackground: Accurate measurement of the corrected QT (QTc) interval is crucial for assessing the risk of arrhythmias. Various formulas, including Bazett’s, Fridericia’s, Framingham’s, and Hodges’, are used to calculate QTc, but discrepancies between them can lead to clinical misclassification. Objectives: This study aimed to compare the performance of different QTc formulas and identify the most reliable method for clinical practice. Methods: A retrospective analysis was conducted on 200 type 2 diabetic patients from South-East London. QT and RR intervals were measured to calculate QTc values. Due to the non-normal distribution of QTc values (Shapiro-Wilk test, p < 0.05), non-parametric statistical methods were employed, including the Friedman test and pairwise Wilcoxon signed-rank tests, to assess differences between QTc formulas. Results: The mean QTc values differed significantly between formulas, with Bazett’s formula producing higher values (445 ± 30 ms) compared to Fridericia’s (426 ± 29 ms), Framingham’s (424 ± 28 ms), and Hodges’ (428 ± 29 ms) formulas. The Friedman test confirmed significant variation across formulas (χ²(3) = 218.86, p < 0.001). Fridericia’s formula demonstrated consistent performance and lower variability compared to other formulas. Conclusion: This study highlights the importance of selecting an appropriate QTc correction formula. Fridericia’s formula may be a more reliable choice for accurate QTc interval measurement in clinical practice, particularly in patients with varying heart rates.
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Autosplenectomy in a patient with autoimmune polyglandular syndrome type 2 (APS-2)Autoimmune glandular syndrome type 2 is a complex genetic condition where a triad of endocrinopathies is involved, namely, Addison's disease, type 1 diabetes, and/or autoimmune thyroid disorder. The disease predisposes one to a variety of other autoimmune associations. Here, we report a rare presentation of a patient with autoimmune polyglandular syndrome type 2 (APS-2) presenting with a 7-year history of progressive splenic atrophy causing functional hyposplenism that ultimately progressed to anatomical asplenia (autosplenectomy) as demonstrated in the serial imaging. We postulate that the underlying cause of this presentation is also of autoimmune nature. Unlike APS-1, which has been linked to hyposplenism, this is the first reported case of APS-2 with similar splenic involvement. Splenic hypofunction can increase susceptibility to encapsulated bacterial infection, with overwhelming postsplenectomy infection (OPSI) being a significant threat. It is crucial that clinicians recognize the importance of providing guidance on vaccinations, antibiotic chemoprophylaxis, and patient education for individuals with asplenia or hyposplenism. If patients with APS can experience progressive splenic atrophy, we suggest long-term follow-up with splenic function assessment. It is yet unclear whether preemptive screening with pitted red cell count has any clinical impact in this group of patients.
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A mysterious case of recurrent confusion: an unusual presentation of congenital intrahepatic portosystemic shuntCongenital portosystemic shunts (CPSS) are rare vascular malformations that divert portal blood into the systemic circulation, bypassing hepatic metabolism. Although typically diagnosed in infancy due to associated congenital anomalies or complications such as hepatic encephalopathy, adult presentations are exceptionally uncommon and diagnostically challenging. We report a 71-year-old female patient with recurrent episodes of confusion and drowsiness who was found to have markedly elevated serum ammonia levels despite normal liver function. Extensive investigations excluded infective, metabolic, and structural causes, and a triple-phase liver computed tomography (CT) revealed multiple intrahepatic portosystemic shunts with aneurysmal dilatation, consistent with congenital origin. Due to multiple comorbidities, the patient was deemed unsuitable for shunt closure or liver transplantation but responded well to medical therapy with lactulose, rifaximin, sodium benzoate, glycerol phenylbutyrate, and L-ornithine L-aspartate, with no further episodes of encephalopathy on follow-up. This case underscores the importance of considering CPSS in adults presenting with hyperammonaemia and altered mental status in the absence of hepatic disease. Early recognition and multidisciplinary management are key to preventing recurrence and optimising outcomes.
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Advancing patient care: the role of advanced clinical practitioners in abdominal paracentesis servicesAbdominal paracentesis is a key therapeutic procedure for patients with ascites, particularly those experiencing liver cirrhosis. While effective in providing rapid symptom relief, the procedure carries potential risks such as infection and haemorrhage. This clinical review explores the role of advanced clinical practitioners (ACPs) in leading paracentesis services within the NHS. It critically examines the benefits of ACP-led services, including improved patient outcomes, reduced waiting times and optimised resource use. By operating across the four pillars of advanced clinical practice, ACPs enhance service efficiency while maintaining high standards of care. The involvement of ACPs in multidisciplinary teams ensures continuity of care and a holistic approach to patient management. In addition, ACPs contribute to ongoing research and provide educational support to trainees, fostering a sustainable model for future healthcare delivery. This review also highlights the potential of ACP-led paracentesis services to alleviate pressure on consultant-led teams, enhance patient satisfaction and meet the growing demand for this critical procedure. Recommendations for future practice include investment in ACP training and developing clear clinical protocols to further optimise service delivery.
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Group consultations in diabetes care: qualitative insights from patients and practitioners to inform service redesignAims: To identify the barriers and enablers influencing the uptake and delivery of diabetes group consultations, drawing insights from patients' and healthcare professionals’ perspectives. Methods: Between September and May 2025, semi-structured interviews were conducted with patients and primary care healthcare professionals. Participants were interviewed to discuss facilitators and barriers to attending or referring patients to attend diabetes group consultations. Using thematic analysis, interviews were coded based on Braun and Clarke's six-phase framework. Results: A total of 11 patients [eight attendees, three non-attendees] and 10 healthcare professionals [GPs, nurses, trainees] agreed to participate in this study. Key barriers identified include logistical challenges (such as scheduling and accessibility), difficulty relating to group dynamics, content relevance and unclear communication about session goals and benefits. Enablers to improve engagement, included structured education on medication management, diet and weight loss, patient segmentation and tailored group models. Peer support also emerged as a factor in reducing patient isolation and fostering shared learning. Conclusions: Uptake of group consultations can be improved by enhancing communication strategies, implementing balanced structured education with facilitated peer sharing, and offering flexible attendance options such as virtual participation or rotational clinics. By addressing barriers and leveraging enablers, group consultations can become a more effective and accessible resource for supporting diabetes management, enhancing patient outcomes and reducing pressures on individual clinical appointments.
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Lower gastrointestinal signs and symptoms: assessment, diagnosis and management strategiesGastrointestinal disorders are one of the most common presentations in primary care. Here Hasan Alsararatee details the investigation process needed to make the right diagnosis
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The contribution of advanced practitioners to equitable and person-centred continence careContinence problems remain widespread across community and secondary care, yet provision in the UK continues to be shaped by inequities, fragmented commissioning, stigma and variation in workforce capability. This article examines the contribution of advanced practitioners (APs) to continence care through the four pillars of practice and considers how their clinical expertise, leadership influence, educational role and engagement with research can strengthen assessment, co-ordination and person-centred support. Evidence from national reports and existing studies demonstrates the need for improved pathways, enhanced staff capability and dignity-focused practice, particularly for populations affected by frailty, cognitive impairment, or cultural and communication barriers. By integrating comprehensive assessment, sensitive communication, culturally responsive engagement and informed use of innovation, APs can advance equitable continence provision and improve the lived experience of individuals with bladder and bowel needs. The article concludes that AP-led practice is essential for progressing continence care within a system that requires greater consistency, stronger evaluation and sustained attention to wellbeing and quality of life.
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Narrative review on post-stroke outcomes through recognition of frailty, sarcopenia, and palliative care needsStroke survivors frequently experience long-term disability, post-stroke fatigue, frailty, sarcopenia, falls, and psychosocial distress, which together drive poorer functional recovery, rehospitalization, institutionalization, and caregiver burden. This narrative review synthesizes contemporary evidence on the prevalence, mechanisms, and clinical impact of post-stroke fatigue, frailty, sarcopenia, and falls and examines their links with palliative care needs, healthcare costs, and emerging telehealth models. A PubMed and Google Scholar search up to October 2025 identified studies on stroke and fatigue, frailty, sarcopenia, falls, palliative care, and telehealth, with an emphasis on clinical studies, trials, systematic reviews, and guidelines in adults. Frailty and sarcopenia are highly prevalent after stroke and predict mortality, poor functional outcome, reduced rehabilitation response, and higher care needs. Post-stroke fatigue is common, multifactorial, and associated with worse quality of life and reduced return-to-work rates. Falls are frequent and arise from the combined effects of focal neurological deficits and systemic frailty/sarcopenia. Despite substantial symptom burden, palliative care is often introduced late and inconsistently. We summarize brief, validated screening tools, such as the Clinical Frailty Scale, SARC-F plus grip strength, Malnutrition Universal Screening Tool, Fatigue Severity Scale/Neurological Fatigue Index for Stroke, Short Physical Performance Battery, and fall-risk instruments. We propose pragmatic timepoints and referral thresholds for their use in stroke services. Multicomponent interventions that integrate exercise, nutritional optimization, psychosocial support, and structured fall prevention can reduce frailty, sarcopenia, and falls and improve function and mood. Telemedicine and telerehabilitation may enhance access and continuity but risk widening digital inequities. Earlier, structured palliative approaches aligned with patient goals are needed across the frailty-sarcopenia-stroke continuum. Implementing integrated screening-intervention pathways and hybrid telehealth models could improve long-term outcomes for stroke survivors and their caregivers while supporting more efficient use of healthcare resources.
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Unmasking pulmonary vein thrombosis: a rare mimic of pulmonary embolismA female in her 50s was referred by her general practitioner (GP) with a 6-day history of left calf pain and swelling. She had a history of recurrent deep vein thrombosis (DVT) and a strong family history of thrombosis involving her mother and sibling. On examination, there was mild tenderness in the left calf with <3 cm asymmetry. Blood tests were normal apart from an elevated D-dimer. Doppler ultrasound ruled out DVT. However, an ECG performed at the GP clinic confirmed paroxysmal atrial fibrillation, and the patient also reported palpitations and shortness of breath at that time. Her Wells score for pulmonary embolism was 7.5, warranting urgent CT pulmonary angiography (CTPA) and initiation of therapeutic enoxaparin. CTPA demonstrated acute pulmonary vein thrombosis rather than pulmonary embolism. A multidisciplinary team discussion was held, and apixaban was commenced following haematology consultation. Follow-up CTPA confirmed complete resolution of the thrombus.
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Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trialsBackground and objective Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC. Methods A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model. Results Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade. Conclusion IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.
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Free fatty acids correlate with the interleukin-1 beta and interleukin-1 receptor antagonist in the early subacute phase of strokeInflammation contributes to the pathogenesis of ischaemic stroke both as a long-term causal factor and through the inflammatory cascade in acute stroke. Interleukin-1 beta (IL-1β) is a potent pro-inflammatory molecule, while interleukin-1 receptor antagonist (IL-1Ra) acts as its antagonist. Free fatty acids (FFAs) play a role in atherosclerosis formation and serve as substrates for inflammatory molecules. This study aimed to determine the potential interplay between FFAs, IL-1β, and IL-1Ra in stroke patients. A prospective analysis was conducted on 73 ischaemic stroke patients. All participants had their FFA, IL-1β, and IL-1Ra levels assessed. Significant correlations between IL-1β and certain FFAs were detected: C15:0 pentadecanoic acid (rho = 0.488), C15:1 cis-10 pentadecanoic acid (rho = 0.473), C17:1 cis-10 heptadecanoic acid (rho = 0.411), C18:0 stearic acid (rho = 0.302), C24:0 lignoceric acid (rho = −0.280), C24:1 nervonic acid (rho = −0.276), C18:2n6t linoleic acid (rho = −0.272), C17:0 heptadecanoic acid (rho = 0.241), and C13:0 tridecanoic acid (rho = 0.238). After multivariate analysis C15:0 pentadecanoic acid remained statistically significant. The strongest correlation was found between IL-1Ra and fatty acids: C15:1 cis-10-pentadecanoid acid (rho = −0.357), C18:2n6t linoleic acid (rho 0.341) and C24:1 nervonic acid (rho 0.302), but after multivariate analysis significantly correlated remained: C22:1n9 13 erucic acid (rho = 0.299), C18:3n6 gamma-linoleic acid (rho = 0.277), with close to significant correlation with C22:4n6 docosatetraenoate (rho = −0.241, p = 0.055). Certain FFAs may play a role in enhancing both pro- and anti-inflammatory responses in the early subacute phase of stroke, where inflammatory and resolving processes are ongoing. Fatty acids such as C15:0 pentadecanoic acid, C15:1 cis-10 pentadecanoic acid and C22:4n6 docosatetraenoate might be involved in pro-inflammatory responses, while C22:1n9 13 erucic acid and C18:3n6 gamma-linoleic acid in the anti-inflammatory pathways with the overlay of IL-1β and IL-1Ra.
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Evaluating advanced clinical practitioners' engagement with the four pillars of advanced practice in the UK: a scoping reviewAims/Background Despite national frameworks outlining the four pillars of advanced practice (clinical practice, leadership and management, education, and research), engagement of Advanced Clinical Practitioners (ACPs) in the UK remains inconsistent, and significant challenges persist. This scoping review aimed to explore ACPs’ engagement with each pillar and to identify both successful and challenging factors. Methods A scoping review was conducted following Arksey and O’Malley’s framework in 2005 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken across five databases (CINAHL, MEDLINE, Scopus, PsycInfo, and Cochrane Library) and grey literature sources. The search covered studies published from 2017 to 2025, in line with the introduction of the Multi-professional Framework. A three-stage screening process was used to identify eligible studies, and data were extracted using a standardised form. Thematic analysis was employed to synthesise the findings. Results Thirty-three studies met the inclusion criteria. The review identified strong ACP engagement in clinical practice, including contributions to direct patient care, improved patient satisfaction, and reduced waiting times. However, engagement with the leadership, education, and research pillars was inconsistent and often limited by excessive workload, lack of protected time, and ambiguity in role definitions. Structural variation across National Health Service (NHS) trusts further contributed to disparities in advanced clinical practice role development and utilisation. Conclusion Advanced clinical practice roles are firmly embedded in clinical care but remain underutilised in leadership, research, and education. Addressing these disparities requires clearer career pathways, organisational investment, and structured policy support to enable ACPs to contribute fully across all four pillars of practice.
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The role of community nurses in rash examination, assessment and managementCommunity nurses play a significant role in the identification, assessment and treatment of rashes and associated skin conditions. It is important for them to be familiar with the location, pattern, appearance and feel of different types of rashes for timely diagnoses and escalation, if required. This article explores the processes of inspection, palpation, diagnostic tools and management strategies relevant to community nursing practice.
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The impact of nutrition misinformation on public health and practice: a reviewThe widespread use of digital platforms, particularly social media, has transformed public access to nutrition information, presenting both opportunities and problems for public health. Although these platforms can enhance health education, they also facilitate the rapid spread of misinformation, often propagated by individuals without professional credentials. Nutrition misinformation shapes public perceptions and behaviours, with detrimental effects on dietary practices and increasing the burden of non-communicable diseases. Online content lacking peer review, scientific grounding or transparency can mislead individuals and erode trust in evidence-based nutrition science. Strategies to counter these effects include strengthening digital and health literacy, implementing policy reforms and ensuring that public health bodies provide accurate, engaging online information to build public resilience against misleading dietary claims.
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Comparing foundation doctors' confidence and dermatologists' expectations in inpatient referrals: a multi-site surveyBackground: Inpatient dermatology referrals rely on non-dermatologist doctors to recognise and communicate skin problems effectively. Limited dermatology training during medical school may leave newly qualified doctors underprepared for this responsibility. Objectives: This study aimed to evaluate foundation doctors' confidence in core dermatological skills and knowledge and to compare these with dermatologists' expectations based on observed inpatient referral quality across two UK hospital sites. Methods: A cross-sectional survey was conducted at Basildon University Hospital and Northampton General Hospital in England. Foundation year doctors (n = 87) completed questionnaires assessing confidence (on Likert scales 1-5) in describing skin lesions, identifying urgent dermatological conditions, knowing what information to include in referrals, and using common treatments. Dermatologists (n = 8) were surveyed on expected referral information, common deficiencies, and examples of inappropriate referrals. Descriptive statistics were used to compare responses. Results: Across both sites, most foundation doctors reported low confidence in describing skin lesions and identifying serious dermatoses: only 8-29% rated themselves "confident" or "extremely confident." Over 65% were not confident in using different emollients (only 2-10% felt confident). Only ~30% of foundation doctors were aware of the British Association of Dermatologists (BAD) handbook. Dermatologists consistently expected detailed clinical information in referrals but noted that many lacked these elements. Common conditions like eczema, psoriasis, scabies, and drug eruptions were cited as being referred inappropriately. Conclusions: Foundation doctors reported limited confidence in fundamental dermatological assessment and management skills, reflecting inadequate undergraduate dermatology training. Dermatologists observed corresponding deficiencies in referral quality. This mismatch may lead to suboptimal patient management and unnecessary specialist referrals. Improving dermatology education for medical students and resident doctors is recommended, alongside clearer referral guidelines and continued dermatologist feedback.
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Use of incentive spirometry to prevent acute chest syndrome (ACS) in patients with sickle cell disease (SCD): a systematic reviewSickle cell disease (SCD) is a genetic hematological disorder that causes the production of sickle-shaped red blood cells. These abnormal cells reduce the oxygen-carrying ability around the body and obstruct blood flow, potentially resulting in devastating complications such as acute chest syndrome (ACS). The objective of this systematic review is to assess whether incentive spirometry is effective in reducing the incidence of ACS in patients with SCD. This review searched databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to August 17, 2025. Randomized controlled trials (RCTs) that used incentive spirometry in patients with SCD were included in the review. Inclusion criteria for this review include patients diagnosed with SCD who have received incentive spirometry, with outcomes compared against standard prevention for ACS or other alternative interventions aimed at preventing or managing lung pathology. Studies must report on at least one of the following outcomes: incidence of ACS, pulmonary function, hospital stay duration, hospitalization rates, or adverse effects. This study found that three RCTs (29 patients, 38 patients, and 20 patients with a total of 124 hospitalizations) were included in this review. Two studies compared incentive spirometry to standard care, while only one compared incentive spirometry to positive expiratory pressure (PEP). A meta-analysis was conducted between two studies, with one trial suggesting that incentive spirometry successfully reduced the incidence of ACS and the other trial suggesting that it could not successfully reduce it. A meta-analysis of both studies found that incentive spirometry did not successfully reduce the incidence of ACS in patients with SCD (RR=0.51; 95% CI (0.21, 1.33)). The quality of this evidence was very low, due to the wide confidence interval, high risk of bias, and substantial heterogeneity. This review concluded that incentive spirometry could not successfully reduce the incidence of ACS in patients with SCD. Limitations of the studies used included small sample sizes and heterogeneity between study populations (i.e., children vs. adults). Therefore, further research is required to assess this, including larger, well-designed RCTs to be conducted focusing on core outcome sets (COS).
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Patterns of antibiotic resistance in community-acquired infections: a study from a tertiary care hospitalBackground: Antibiotic resistance in community-acquired infections (CAIs) has emerged as a growing global concern with serious clinical and public health implications. Rising resistance to first-line therapies is reducing treatment effectiveness, increasing healthcare costs, and contributing to higher morbidity and mortality. Objective: The objective is to evaluate the patterns of antibiotic resistance among bacterial isolates from CAIs in patients presenting to a tertiary care hospital and to assess their associated clinical outcomes to inform empirical therapy and support antimicrobial stewardship initiatives. Methodology: A descriptive observational study was conducted at the Microbiology Department of Gujranwala Medical College, Gujranwala, Pakistan, from February 11, 2024, to February 11, 2025. The study included 560 individuals with suspected CAIs who tested positive for bacterial infection. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute guidelines. Data analysis was conducted using Statistical Package for the Social Sciences version 26 (IBM Corp., Armonk, NY). Results: Of the 560 patients, 314 (56.07%) were men and 246 (43.93%) were women; 188 patients (33.57%) were aged 18-40 years. The most common specimen was urine (n = 234, 41.79%), followed by blood (n = 112, 20.00%). The predominant pathogens were Escherichia coli (n = 216, 38.57%) and Staphylococcus aureus (n = 104, 18.57%). Among E. coli isolates, 169 (78.24%) showed resistance to ciprofloxacin and 153 (70.83%) to ceftriaxone. Methicillin-resistant S. aureus (MRSA) was identified in 67 of 104 isolates (64.42%). Multidrug-resistant (MDR) organisms were detected in 188 patients (33.57%) and were significantly associated with treatment failure (38.30%), prolonged hospital stay (53.72%), antibiotic escalation (68.62%), and inhospital mortality (11.17%). Carbapenem-resistant infections were found in 32 patients (5.71%), with a mortality rate of 28.13% (n = 9). Conclusion: This study demonstrates a high burden of MDR organisms in CAIs, with poor clinical outcomes, particularly in carbapenem-resistant and MRSA infections. These findings emphasize the urgent need for strengthened antimicrobial stewardship, continuous surveillance of resistance trends, and locally tailored empirical treatment guidelines in community healthcare settings.
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The "forgotten disease" in a healthy young adult: a case report of lemierre's syndromeLemierre's syndrome is a rare, life-threatening condition caused by the anaerobic bacterium Fusobacterium necrophorum, typically affecting otherwise healthy individuals. The case report aims to raise awareness of this often-overlooked condition to help prevent associated morbidity and mortality. We present the case of a 22-year-old male who developed sepsis secondary to upper and lower respiratory tract infections. The patient experienced a four-week history of worsening cough and shortness of breath, followed by the onset of fever. His clinical condition rapidly deteriorated, leading to sepsis and type 1 respiratory failure, although invasive ventilation was not required. Computed tomography (CT) scans of the neck and chest revealed thrombosis of the right internal jugular and right pharyngeal veins, along with septic emboli in the lungs. Growth of Fusobacterium necrophorum in blood culturesconfirmed the diagnosis of Lemierre's syndrome. Aggressive treatment with antibiotics and anticoagulants resulted in a full recovery and resolution of thrombosis. Although rare, Lemierre's syndrome remains a potentially fatal condition, and clinicians should maintain a high index of suspicion.
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Recognizing haemophagocytic lymphohistiocytosis in an HIV patient with disseminated tuberculosis: not every fever is sepsisHaemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition that causes hyperinflammation, extensive tissue destruction, multi-organ failure (MOF) and death due to uncontrolled activation and proliferation of T cells and macrophages. HLH can be primary (genetic) and secondary (acquired). Primary HLH occurs due to genetic mutations, and secondary HLH is often triggered by autoimmune diseases, infections (commonly viral, bacterial and parasites) and malignancies, such as lymphoma. We report a case of secondary HLH in a 43-year-old man with an untreated human immunodeficiency virus (HIV) infection and newly diagnosed disseminated tuberculosis who was admitted to the acute medicine ward with some non-specific gastrointestinal symptoms. Nevertheless, he was treated with guideline-directed antibiotics, but his condition failed to improve with persistent high-grade fever, haemodynamic instability, splenomegaly, pancytopenia, transaminitis and hyperferritinaemia (ferritin: >18,000 μg/L). Hence, the multidisciplinary team (MDT) initiated a workup including the Haemophagocytic Lymphohistiocytosis Diagnostic Score (HScore) and bone marrow biopsy, along with viral screening, tuberculosis (TB) tests and computed tomography (CT) of the chest, abdomen and pelvis, followed by bronchoscopy. The clinical diagnosis of HLH was established based on the highly supportive clinical and laboratory criteria, as reflected by an extremely high HScore (272), despite the absence of haemophagocytosis on bone marrow biopsy. Later, the bronchial washing confirmed the detection of Mycobacterium tuberculosis. Our rheumatology, haematology and acute medicine team consensually agreed to start intravenous (IV) pulse methylprednisolone for three days, followed by antiretroviral and anti-tubercular regimens. This case underscores the diagnostic challenge of HLH in untreated patients with HIV and disseminated TB, where the clinical manifestations can resemble sepsis, cytokine storm or systemic inflammatory response syndrome (SIRS). Ultimately, early identification and timely intervention with immunosuppressive therapy are crucial for the favourable outcome of patients with HLH.