Visceral leishmaniasis-associated hemophagocytosis: a single center experience.

BACKGROUND Kala-azar is a multisystem infection of the reticuloendothelial system. Various hematologic abnormalities have been described in kala-azar including hemophagocytic syndrome (HPS).  METHODS We reviewed bone marrow aspirate smears from 18 documented cases of kala-azar complicated by HPS.  RESULTS The bone marrow smears were hypercellular with erythroid hyperplasia. Megaloblastic changes, foamy macrophages, activated macrophages with cytoplasmic vacuoles and elongated cytoplasmic process, intra- and extracellular amastigotes, cytoplasmic fragments (blue bodies), plasma cells with inclusions and hemophagocytic cells were seen. Leishman bodies (amastigotes) were also found in some hemophagocytic cells. CONCLUSION Kala-azar should be considered as an etiology of HPS, particularly in endemic areas.