Table 1.

Summary of pertinent investigations performed throughout this case

Haematology	Microbiology & Virology	Imaging
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.