
Visceral leishmania, known as Kala Azar, is a rare but increasing disease especially in Lebanon. The protozoan parasite proliferates in the reticulo-histiocyte system producing a large spectrum of different symptoms that can mimic other diseases like malignancies. HL-Hemophagocytic lymphohistiocytosis is a possible complication that can rapidly deteriorate the patient clinical situation and make the diagnosis even more difficult. We report a challenging case of fever and pancytopenia in an otherwise well looking Lebanese 3 years old girl.