A 50-year-old man came to the emergency room of a university hospital complaining of weight loss, fever and abdominal pain associated with hepatosplenomegaly. Laboratory investigations revealed pancytopenia with red blood cell (RBC) count of 2.35×1012/L, hemoglobin 7.2g/dL (RBCs with rouleaux formation), platelets of 75.7×109/L, white blood cell count of 2.77×109/L (with 58% neutrophils, 27% lymphocytes, 15% monocytes, 0% eosinophils and 0% basophils), hypoalbuminemia (1.31g/dL) and hypergammaglobulinemia (6.63g/dL). Serological test results were negative for antibodies for hepatitis (B and C) and human immunodeficiency virus (HIV). Due to the laboratory findings and sustained pancytopenia, a bone marrow biopsy was performed which showed Leishmania amastigotes phagocytosed by macrophages (Figure 1) confirming the diagnosis of visceral leishmaniasis infection.1,2

Figure 1.

Leishmania amastigotes phagocytosed by macrophages. Black arrows show amastigotes (May-Grünwald stain; (A) magnification: 400×, (B) magnification: 1000×).