A Rare Presentation of Leishmaniasis

Leishmaniasis or kala-azar is a protozoan disease that can present as cutaneous, mucocutaneous, visceral, and disseminated disease. In India, it is usually localized in distinct areas of Bihar, Jharkhand, West Bengal, and parts of Eastern Uttar Pradesh. Visceral leishmaniasis (VL) involves the visceral organs, mainly the liver, the spleen and bone marrow. VL is characterized by prolonged fever, massive splenomegaly, weight loss, progressive anemia, pancytopenia, and hypergammaglobulinemia, and can be complicated by serious infections. In most of the patient the diagnosis is made on bone marrow biopsy or splenic aspirate. We hereby present an unusual case of kala-azar in a 52-year-old patient non-resident of endemic area presenting with pyrexia of unknown origin, in whom bone marrow biopsy was negative for Leishmanin Donovan (LD) bodies, and diagnosis was made by liver biopsy in which LD bodies were seen.