Visceral leishmaniasis masquerading as drug-induced pancytopenia in myasthenia gravis

Visceral leishmaniasis (VL), also known as kala-azar (black fever in Hindi), is a disease primarily caused by Leishmania donovani. The most important clinical manifestation of visceral fever. Nonspecific laboratory findings include anemia, neutropenia, eosinopenia, and thrombocytopenia. Definitive diagnosis requires the demonstration either parasite smear or tissue culture (usually bone marrow spleen). Myasthenia gravis an autoimmune antibodies to acetylcholine receptors post-junctional membrane neuromuscular junction. It typically presents with fatigable muscle weakness without any sensory brain involvement. usually treated corticosteroids immunosuppressants like azathioprine. Here we encountered confirmed case myasthenia on azathioprine pancytopenia. While working up evaluate pancytopenia, examination revealed presence Donovan bodies patient showed good response liposomal amphotericin-B. In retrospect, gravis, who presented pancytopenia presumably drug-induced, was found have leishmaniasis.