Visceral leishmaniasis concealed under a diagnosis of haemophagocytic lymphohistiocytosis.

Diagnosing secondary haemophagocytic lymphohistiocytosis (sHLH) requires a systematic approach to avoid the potentially fatal consequences. A young man in his 30s, residing in the northwestern part of India, presented to us with fever, poor appetite and weight loss for over 3 months. Primary evaluation at a regional hospital showed that the patient was having hepatosplenomegaly and pancytopenia. The treating team considered a diagnosis of primary HLH and treated him with an etoposide-based regimen. Because of the rapid clinical deterioration and non-responsiveness to therapy, he was referred to our centre. We pursued the possibility of sHLH and repeated a bone marrow examination, which showed Leishmania donovani bodies with haemophagocytosis. Thereafter, the patient was prescribed liposomal amphotericin B, but unfortunately, he succumbed to the illness. This case reiterates that infection is a frequent trigger of sHLH. The diagnosis of primary HLH in adults should be considered only after excluding all putative infectious causes, particularly in tropical regions.