Visceral leishmaniasis with haemophagocytic lymphohistiocytosis: the importance of scrutinising your samples

A 52-year-old woman presented with a four-week history of fever, splenomegaly and weight loss. She had previously been diagnosed with orofacial granulomatosis, and was receiving long-term treatment with azathioprine and low dose prednisolone. Eleven months prior to presentation she had been on holiday to southern Spain, with no other significant foreign travel. Blood tests showed pancytopenia with severe neutropenia, which did not improve on...