Hemophagocytic lymphohistiocytosis associated with visceral leishmaniasis

A 2 year-old child presented with fever and hepatosplenomegaly. Laboratory findings showed pancytopenia, hypertriglyceridemia, hyperferritinemia, and high levels of soluble-IL2 receptors. Initial bone marrow aspiration and bi opsy revealed mild hemophagocytosis. A diagnosis of hemophagocytic lymphohi stiocytosis was made and appropriate treatment was begun. Repeated marrow a spiration performed because of lack of clinical response revealed Leishmani a amastigotes in macrophages in addition to active hemophagocytosis. Treatm ent with liposomal amphotericin resulted with rapid recovery. Visceral leis hmaniasis should be considered in the differential diagnosis of hemophagocy tic syndrome.