Chronic pancytopenia, severe splenomegaly, and splenectomy: the importance of histopathology

Background: In Latin America, the incidence of visceral leishmaniasis (VL) in children is unknown.In addition, there are very few pediatric reports from Central America and the Caribbean.In Costa Rica, the first pediatric case was published in 1999, although the patient was diagnosed in 1995.Since then, no other cases have been published.Clinical case: We describe the case of a 2-year-old female who presented with prolonged fever, pancytopenia, and massive splenomegaly, and who was diagnosed with VL incidentally after splenectomy.She was successfully treated with amphotericin B for 14 days.The evolution has been favorable, with no sequelae at 5 years follow-up.These clinical presentations are very uncommon.Conclusions: Even in non-endemic countries, VL should be considered as a cause of massive splenomegaly in tropical countries, and should be considered within the differential diagnosis of patients presenting with fever, splenomegaly, pancytopenia, hepatomegaly, and/or lymphadenopathy.