Clinical features common to the three patients initially include fever, headache, diarrhoea and myalgia developing into rash and hepatic dysfunction, followed by rapid deterioration and death.

Conclusion Awareness of diagnosis of HPS is crucial when patients have unknown hepatic dysfunction, fever, hepatosplenomegaly and pancytopenia.

The side effect included varying degrees fever, thoracalgia and gastrointestinal upset, without arrest of bone marrow and hepatic or renal in-jury.