Visceral Leishmaniasis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesVisceral LeishmaniasisRACP Adult Medicine

A 40-year-old woman presents with fever, pancytopaenia, and splenomegaly after returning from India. Peripheral blood film shows intracellular amastigotes in monocytes. What is the most likely diagnosis?

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Correct answer: D — Visceral leishmaniasis

Intracellular amastigotes (Leishman-Donovan bodies) within monocytes/macrophages on peripheral blood film or bone marrow aspirate is diagnostic of visceral leishmaniasis (kala-azar). It presents with prolonged fever, pancytopaenia, hepatosplenomegaly, and hypergammaglobulinaemia. Treatment in Australia is with liposomal amphotericin B.

Reference: eTG – 2025 – Antibiotic Guidelines; WHO – 2022 – Leishmaniasis Guidelines