Beta Thalassemia is a hereditary blood disorder characterized by defect in synthesis of beta chains of haemoglobin requiring regular blood transfusion and chelation therapy. Blood transfusions can lead to many complications of which transfusion transmitted infections like HCV, HBsAg, HIV etc are possible. Iron overload is another complication of repeated blood transfusion which further predisposes them to many infections like Mycobacterium Tuberculosis. Hemophagocytic Lymphohistiocytosis (HLH) is one of the rare complication where there is abnormal activation of immune system which results in cytokine storm. Here we present a case of transfusion dependent thalassemia patient, who developed HCV and Pulmonary Kochs complicated with HLH all at the same time and was managed successfully.