Hemophagocytic lymphohistiocytosis (HLH) is a condition that demands a high index of suspicion and necessitates differentiation from sepsis as the treatment approaches for these two conditions diverge. Patients afflicted with hematological malignancies are susceptible to developing secondary HLH syndrome, which can arise either due to the malignancy itself or due to infections that emerge during chemotherapy. Prudent administration of chemotherapy regimens and the early identification of secondary HLH, whether attributed to malignancy or to infections, are pivotal in tailoring appropriate treatments and thereby mitigating mortality. This case involves a 50-year-old male diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) and undergoing induction chemotherapy. The patient exhibited refractory shock without discernible sources of infection on routine cultures, along with normal procalcitonin levels. Additionally, acute liver failure and pancytopenia developed. Through diagnostic investigations, hemophagocytes were identified in bone marrow biopsy, and cytomegalovirus (CMV) viral load was detected in the blood, satisfying the Histiocyte Society's criteria for HLH. HLH often mimics sepsis, even though it can itself be triggered by an infection. Hence, it is imperative to accurately identify, differentiate, and treat both conditions appropriately.