Background: Visceral leishmaniasis can create some unusual clinical manifestations such as hematemesis and also, in rare cases, with peripheral blood involvement. Therefore, these manifestations can be considered in early diagnosis of the disease.
Case presentation: A 9 year-old boy was admitted to Imam Reza teaching hospital in Mashhad, Iran in 2010 with fever, sweating, abdominal distention, massive hematemesis, weight loss, huge splenomegaly and hepatomegaly. Peripheral blood smears and also bone marrow aspiration (BMA) and biopsy showed leishman bodies in monocytes/macophges.
Conclusions: Although the sensitivity of blood smears for diagnosis of the parasite is low, it is an easy and accessible test we advise to perform for all patients suspected to visceral leishmaniasis in endemic area. We also suggest screening tests for visceral leishmaniasis to be considered in blood donors in the endemic areas.