Haemophagocytic syndromes or syndromes involving macrophage activation are rare complications of tuberculosis, whether they be pulmonary or polyvisceral. They are characterised by an anomalous increase in the phagocytic power of macrophages with phagocytosis of the formed elements of blood. The clinical biological picture associates a change in the general physical state accompanied by organomegaly, hyperferritinaemia and pancytopenia. Their occurrence is a poor prognostic factor and few treatment seem to check this mechanism. The authors report a rare case of marked macrophage activation syndrome complicating pulmonary tuberculosis in a patient who was HIV negative without an underlying blood disturbance and a favourable outcome.