Presentation
A three-week course of fever, abdominal pain, arthralgia and pancytopenia.
Patient Data
Splenomegaly with multiple nodular hypodense lesions of variable sizes (better appreciated on the axial windowed stack).
No significant abdominal lymphadenopathies.
Case Discussion
Splenomegaly with multiples hypodense lesions on CT has a broad differential diagnosis: malignancy (lymphoma, metastases), infarctions, abscesses (usually as septic emboli), granulomatous diseases (tuberculosis, sarcoidosis, bartonellosis) and benign lesions (haemangiomatosis, multiple hamartomas), among others.
The first diagnostic option in this case, taking into account the clinical picture and the imaging findings, was lymphoma.
The patient went to have a bone marrow aspirate, which revealed a positive PCR for Leishmania. Visceral leishmaniasis or kala-azar was finally diagnosed and treatment with Amphotericin B was initiated.