Abstract: Pulmonary tuberculosis is a common infectious disease in China, and primary syndrome is more common in children. Tuberculous meningitis is the most critical disease among children with tuberculosis, which is progressing rapidly, with high disability and mortality rates. Hemophagocytic syndrome (HLH) is a group of diseases with rapid progress and high mortality, and its incidence rate is high in children. If the patient also has pulmonary tuberculosis, tuberculous meningitis, and hemophagocytic syndrome, early diagnosis and correct treatment are crucial for the patient's prognosis. This article reports a 10-year-old child who sought medical attention due to recurrent fever and cough. Previously healthy with no underlying diseases. The preliminary diagnosis of this illness is pneumonia, and there has been no improvement after active treatment in an external hospital. Bone marrow puncture shows hemophagocytic cells, and the condition worsens and is transferred to our hospital. After admission to our hospital, the diagnosis was severe pneumonia and HLH. HLH was treated according to the guidelines, and antibiotics, fungal infections, and immunoglobulin support therapy were given. The symptoms of the patient did not improve, but the condition continued to worsen. Further examination showed positive Mycobacterium tuberculosis in the cerebrospinal fluid and positive sputum X-pert (rapid molecular identification of tuberculosis and rifampicin resistance). Four combination anti tuberculosis treatment was given, but the patient developed brain herniation in the later stage and died after giving up treatment. This article discusses the clinical manifestation, imaging changes, pathogenic examination, diagnosis and treatment process of hemophagocytic syndrome caused by pulmonary tuberculosis and tuberculous meningitis, so as to improve clinicians' understanding of HLH induced by severe tuberculosis in children.

Key words: Pulmonary tuberculosis, Tuberculous meningitis, Hemophagocytic syndrome