Table 1

Summary of pertinent investigations performed throughout this case

HaematologyMicrobiology & VirologyImaging
Folate deficiency
Iron deficiency
HSV PCR negative
HHV6 negative
Varicella zoster negative
HSV type 1 and type 2 negative
Enterovirus RNA negative
Adenovirus DNA negative
EBV PCR <150 IU/mL
CMV PCR <200 copies/ml
Stool MC&S negative
Parvovirus PCR negative
Cryptococcal antigen negative
Toxoplasma IgG negative
Legionella antigen-negative
Mycobacterial blood cultures-negative
Galactomannan-positive test 0.26
Beta glucan positive 119 pg/mL
Serum Leishmania PCR negative
Leishmaniasis serology positive titre ≥1:102 400
MRCP: 22 cm splenomegaly, no intrahepatic dilatation, upper abdominal varices
CT thorax, abdomen and pelvis: right sided pleural effusion, splenomegaly
Echocardiogram: no evidence of vegetations
CT PET: massive splenomegaly with increased uptake
Pleural fluid and broncho alveolar lavage
Broncho alveolar lavage negative aspergillus PCR
Pleural aspirate: ph 7.4, exudate, MC&S negative
Acid fast bacilli not seen
Mycobacterium negative
Bone marrow aspirate: Small atypical B cells, amastigotes present Bone marrow
Leishmania PCR positive
16S DNA-no DNA detected
Pneumocystis jirovecii PCR-negative
Toxoplasma PCR-negative
Bacterial MC&S-negative
Panfungal PCR-negative
  • CMV, cytomegalovirus; CT, computerised tomography; CT PET, computerised tomographic- positron emission tomography; DNA, deoxyribonucleic acid; EBV, Epstein-Barr virus; HHV 6, human herpes virus 6; HSV, herpes simplex virus; IgG, immunoglobulin G; MC&S, microscopy, culture & sensitivity; MRCP, magnetic resonance cholangiopancreatography; PCR, polymerase chain reaction; RNA, ribonucleic acid.