A 45-year-old male presented with a history of fever for two months and a splenomegaly on physical examination. Laboratory examination revealed a white blood cell count of 4,300/µl, hemoglobin of 8.5g/dl and platelet count of 150,000/µl. Persistent fever and anemia prompted the bone marrow evaluation. Presence of leishmania in bone marrow established the diagnosis of Visceral leishmaniasis. The rK39 rapid immunochromatographic test (ICT) was also found to be positive, thus supporting the diagnosis. 

Visceral leishmaniasis is caused by the protozoan parasite Leishmania donovani and is transmitted by the bite of infected sandfly. The infection commonly affects immunocompetent patients in endemic areas (South America, Northeast Africa, India, Mediterranean basin) and immunocompromised patients. It preferentially affects reticuloendothelial cells and commonly presents with fever, pancytopenia and splenomegaly.