Background: Macrophage activation syndrome is a rare and life threatening complication of childhood rheumatic disorders.
Case Characteristics: 6-year-old male child with macrophage activation syndrome complicating systemic onset juvenile idiopathic arthritis.
Observation: He developed pericardial effusion, hyponatremia and deranged renal function.
Outcome: Improvement on intravenous cortico steroids.
Message: High index of suspicion can lead to earlier diagnosis of macrophage activation syndrome.
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