Question
An 11 month old girl resident of Mumbai born of non consanguineous marriage presented with cough and fever since 15-20 days. She had diarrhea with septic shock, meningitis and anemia 2 months back for which she was hospitalized and treated with intravenous antibiotics and blood transfusion. She was alright for 1 month and again had pneumonia with anemia and was again treated with intravenous antibiotics and blood transfusion. However, now fever has restarted since 20 days. Birth history, immunization, development is uneventful. On examination, she had pallor, hepatosplenomegaly with generalized lymphadenopathy.

Investigations over a period of 2 months are as follows:

• CSF = 16 cells, cumm {all lymphocytes}, 59 sugar with proteins of 105 mg, dl
• Renal functions and liver functions = Normal
• HIV, Leptospira, Dengue ELISA = Negative
• Hemoglobin electrophoresis = Normal
• S. cholesterol = 110 mg, dl
• Blood culture = Staphylococcus aureus
• Bone Marrow aspiration {Day 48} prior to 2nd blood transfusion = LD bodies
• Prothrombin time and Partial thromboplastin time = Prolonged
• Fibrinogen = 250 mg percent {increased}
• Ferritin = 1293 IU, L {Normal = 7-140 IU, L}
• Chest X-Ray = Right lower zone pneumonia

This child had never been to an area endemic for Kalaazar though mother had been there 6 months prior to getting pregnant. Child was treated with Inj Amphotericin B to which the fever, pancytopenia responded and hepatosplenomegaly regressed.